Bacteriology 
m  a  Nutshell. 


Agric.  D«»t. 


Bacteriology  in  a  Nutshell 


A  Primer  for  Junior  Nurses 


COMPILED    AND    ARRANGED    BY 


GRADUATE    NURSE, 

Late    Superintendent     Thomas     Hospital     Training     School     for 

Nurses,  Charleston,  W.  Va.;  Assistant  Instructor  in  General 

Nursing,  Woman's   Branch   of  the  German   Hospital 

Cincinnati,  O.  ;  Principal  of  the  Training  School 

and  Superintendent  of  Nurses,  Charles- 

ton General  Hospital,  Charleston, 

W.   Va.,    1905-07. 


REVISED  AND  ENLARGED  1907. 


DEDICATION : 

To  Charlotte  A.  Aikens,  Associate  Editor  The  National  Hospital 
Record,  to  whose  suggestion  this  booklet  owes  its  origin;  to  my 
dear  friend  and  old  Superintendent,  Sister  Emilie  Koch,  of  the 
German  Hospital,  Cincinnati,  Ohio;  and  to  my  sister  nurses 
throughout  the  world  "Bacteriology  in  a  Nutshell"  is  most 
affectionately  dedicated. 


;INCINNATI,    OHIO. 
JULY,     1904. 


LIBRARY  of  CONGRESS 

Two  Ccoies  Received 

JAN  13   1908 

Cowiffu  tntry 
t^V    (-2,    /ft/ 7 
CLASS  %       XXc,  No, 

iiin 

COHY    A. 


COPYRIGHT    1904 
BY    MARY    E.    REID. 


BIOLOGY 

LIBRARY 

G 


COPYRIGHT    1907, 
BY    MARY    E.   REID. 


DUPLICKfE 


CONTENTS. 

INTRODUCTORY    5-7 

CHAPTER  I. — BRIEF  HISTORY  OF  BACTERIOLOGY. 

Earliest  days. — Perfection  of  the  single  lens. — 
The  ''Dutch  Microscopist." — His  discoveries. — 
The  compound  microscope. — First  account  of  the 
germ  theory  of  disease. — A  problem  of  ancient 
bacteriology. — Men  who  have  made  valuable  con- 
tributions to  the  science. — Their  discoveries.  .9-23 

CHAPTER  II. — THE  RELATION  OF  BACTERIA  TO  DISEASE. 
BACTERIA  IN  PROCESSES  OF  -NATURE. 

Mysteries  revealed  by  the  microscope. — Cell 
formation. — The  organs  and  systems  of  the 
body. — Health  dependence. — Cell  functions. — 
Cell  derangement. — The  term  bacteria. — Bacteria 
as  friends. — Bacteria  as  enemies. — The  first  use 
of  the  term  bacteria. — Relative  size  of  sapro- 
phytic  and  parasitic  families' 23-33 

CHAPTER    III. — DESCRIPTION   OF   THE   MOST   IMPORTANT 
BACTERIA. — METHODS  OF  MULTIPLICATION,  ETC. 

Morphology.  —  Spore-forming  bacteria.  —  Non- 
spore-forming  bacteria. — Development. — Multipli- 
cation.— Dimensions. — Coloring  bacteria. — Pha- 
gocytes. —  Phagocytosis.  —  Opsonius.  —  Resistive 
power  of  spores. — Parent  bacillus  after  spore 
formation ;  its  life  or  death. 33-44 

CHAPTER    IV. — BACTERIAL    INVASION. — How     BACTERIA 
GAIN  AN  ENTRANCE  TO  THE  SYSTEM. 

Parke's  list  of  communicable  diseases. — Period  of 
incubation. — Invasion. — Channels  of  Entrance. — 
Development  of  symptoms. — How  infection  is 
thrown  off. — Sources  whereby  bacteria  die  within 
the  body. — Immunity,  natural,  acqiured,  artificial. 
— Antitoxins — their  preparation  and  uses. — Koch's 
Circuit.— The  Opsonic  Theory 44-64 

CHAPTER  V. — COMMON  COMMUNICABLE  DISEASES. 

Why  the  term  communicable  has  taken  the  place 
of  the  terms  contagious  and  infectious. — The 
bacteria  found  present  in  some  of  the  diseases 
mentioned. — Transmission  of  diseases. — Seat  of 
invasion  or  attack. — Effects  of  invasion. — Multi- 
plication or  extermination  of  germs. — Fresh  air 
and  ventilation  in  communicable  diseases. — Bac- 
teria in  water,  milk  and  so  forth. — Duties  of  the 
nurse  in  communicable  diseases...  __...,  ,64-101 

288439 


CHAPTER    VI. — BACTERIA    IN    SURGERY. — SEPSIS. — ASEP- 
SIS.— ANTISEPSIS. 

Bacteria  most  frequently  found  in  surgery ;  cases  in 
which  they  occur. — Sepsis.  Asepsis.  Antisepsis. 
Causes  of  sepsis. — Why  sepsis  should  not  occur 
in  the  present  age. — Why  surgeons  and  nurses 
dread  sepsis. — The  debt  the  world  owes  to  Lord 
Lister. — The  vigilant  nurse. — Sterilization. — Dis- 
infection. —  Antiseptics.  —  Germicides.  —  Deodor- 
ants.— Heat  as  a  germicide. — Intermittent  steril- 
ization.— Aseptic  surgery. — Hand  disinfection. — 
Disinfection  of  instruments,  rooms,  furniture, 
beds,  bedding,  etc 101-120 

CHAPTER    VII. — SOLUTIONS,    THEIR    PREPARATION    AND 
USES. — FUMIGATION. 

Some  of  the  drugs  in  common  use  for  the  prepar- 
ation of  solutions,  how  prepared,  how  used. — 
Normal  salt  solution,  when  and  how  used. — 
Sterile  water. — Filtered  water. — Distilled  water. — 
Alcohol.  —  Ether.  —  Sulphur  fumigation.  —  For- 
maldehyde.— Formalin. — "Hospital  Formulary" 
giving  number  of  grains  used  in  preparation  of 
solutions  of  various  strength. — A  common  rule 
for  the  preparation  of  solutions  from  drugs  in 
liquid  form  where  absolute  accuracy  is  not  re- 
quired   120-128 

CHAPTER  VIII. — HYGIENE  FOR  NURSES. 

The  result  of  neglected  hygienic  laws. — Civiliza- 
tion, fashion,  and  hygiene. — Social  restrictions  no 
longer  a  menace  to  hygienic  laws. — Out  of  door 
recreation. — Average  length  of  days  of  the  con- 
scientious nurse. — How  this  period  may  be  pro- 
longed.— The  successful  nurse. — Her  duty  toward 
her  neighbor. — Her  duty  toward  herself. — Muscu- 
lar exercise. — Hygienic  dress. — Uniform  should 
not  be  worn  on  the  street. — The  reason  why. — 
Obedience  to  Nature's  calls. — Diet. — Water  sup- 
ply. Sunshine. — Fresh  air. — Rest. — Sleep. — The 
nurse  with  "a  Southern  exposure" 128-153 


BACTERIOLOGY  IN  A  NUTSHELL. 

INTRODUCTORY. 

In  compiling  this  small  primer  of  bacteri- 
ology for  junior  nurses,  the  work  along  bacteri- 
ological lines  prepared  as  one  of  the  members 
of  the  class  of  students  of  'The  Graduate 
Nurses'  Hospital  Extension  Course,"  in  Oc^o- 
ber,  1903,  has  been  used  as  a  basis.  Nothing 
new  in  the  way  of  theory  has  been  attempted. 
Much  rather  would  the  writer  join  the  ranks 
of  her  sister  nurses  who  so  bravely  have  en- 
listed to  help  the  noble  army  of  physicians  and 
surgeons  fight  a  victorious  warfare  against  that 
branch  of  the  bacteria  family  called  "disease 
germs."  Most  gladly  would  we  all  as  nurses 
see  these  tiny  foes  to  health  destroyed  forever. 

Superintendents  of  training  schools  have 
realized  for  some  years  that  a  few  easily  com- 
prehended lessons  on  bacteriology  for  junior 
nurses  are  necessary.  The  sole  aim  of  "Bac- 
teriology in  a  Nutshell"  is  to  present  to  young 
nurses  just  starting  out  in  the  study  of  the 
germ  theory  of  disease  some  of  its  principal 
teachings  as  briefly  and  as  simply  as  possible. 
If  the  contents  of  this  booklet  have  been  made 
sufficiently  clear  to  be  easily  grasped  by  those 
for  whose  benefit  it  is  intended,  and  if  it  serves 
as  an  incentive  to  further  study  and  research 
into  this  most  interesting  and  useful  branch  of 
5 


science,  the  result  will  be  more  than  gratifying 
to  the  writer  and  of  lasting  benefit  to  student 
nurses. 

Much  assistance  has  been  obtained  from  a 
review  of  the  work  of  hospital  training  school 
days  and  notes  of  lectures  of  Dr.  E.  Gustave 
Zinke,  Dr.  Magnus  A.  Tate  and  Dr.  James  W. 
Rowe,  particularly  lectures  with  regard  to 
Sepsis,  Asepsis,  Antisepsis,  Infection,  Disin- 
fection, Sterilization,  etc.  In  addition  to  these 
helps,  my  own  experience  of  recent  years  as  a 
teacher  in  training  schools  has  proven  of  ma- 
terial benefit. 

My  thanks  are  especially  due  to  Dr.  James 
W.  Rowe  for  valuable  information  with  regard 
to  the  discoverers  of  bacteria,  given  to  me  since 
beginning  the  preparation  of  the  primer,  and 
also  for  helpful  suggestions  during  -the  work 
of  proof  reading;  to  Miss  Aikens,  of  the  Na- 
tional Hospital  Record,  for  assistance  in  out- 
lining the  plan  of  the'  book ;  to  Miss  Susie  L. 
Wanzer,  one  of  the  old  pupils  of  the  Thomas 
Hospital  Training  School  for  Nurses,  Charles- 
ton, W.  Va.,  who  so  efficiently  assisted  in 
preparing  the  manuscript  for  publication,  and 
who  also  made  for  me  the  drawings  for  cuts 
representing  the  forms  of  bacteria  mentioned 
in  the  text. 

MARY  E.  REID. 

Cincinnati,  O.,  July,  1904. 


INTRODUCTION  TO  REVISED 
EDITION. 

The  kindly  reception  given  to  the  first  edition 
of  Bacteriology  in  a  Nutshell,  by  Superintend- 
ents of  training-schools  for  nurses  and  by 
graduate  nurses  throughout  the  United  States, 
has  been  much  appreciated  by  the  author.  In  re- 
vising and  enlarging  the  primer  all  authorities 
have  been  consulted.  The  book  is  again  sent 
forth  with  the  hope  and  expectation  that 
teachers  and  pupils  in  training  schools  may  find 
it  more  than  ever  helpful. 

My  thanks  are  again  due  to  Dr.  Zinke,  of 
Cincinnati,  Ohio,  for  a  careful  review  of  the 
revised  portions  of  the  primer ;  to  Miss  Aikens, 
of  the  National  Hospital  Record,  and  to  Dr. 
John  E.  Cannaday,  of  Sheltering  Arms  Hos- 
pital, W.  Va.,  for  valuable  advice  during  the 
work  of  revision,  and  to  Dr.  Charles  O.  Grady, 
of  the  Charleston  General  Hospital,  Charles- 
ton, W.  Va.,  for  information  and  clipping 
concerning  the  opsonic  theory. 

MARY  E.  REID. 

Charleston-on-Kanawha,  W.  Va.,  October,  1907. 


MODIFIED  OATH. 

The  principles  set  forth  in  the  following  "modified 
oath,"  which  the  nurses  of  the  Brooks  Memorial  Hos- 
pital, Dunkirk,  N.  Y.,  are  required  to  take  at  their 
graduating  exercises,  deserve  a  place  opposite  the  initial 
page  in  every  text-book  written  for  nurses.: 

"I  solemnly  promise  and  swear  that  in  the  practice 
of  my  profession  I  will  always  be  loyal  to  the  patients 
entrusted  to  my  care  and  to  the  physicians  under  whom 
I  shall  serve.  That  I  will  not  make  use  of  nor  recom- 
mend any  quack  or  secret  nostrum.  That  I  will  be 
just  and  generous  to  members  of  my  profession,  aiding 
them  when  they  shall  need  aid  and  I  can  do  so  without 
detriment  to  myself  or  to  my  patient.  That  I  will  lead 
my  life  and  practice  my  profession  in  uprightness  and 
honor.  That  I  will  not  lend  my  aid  to  any  criminal  or 
illegal  practice  whatever.  That  into  whatever  house  I 
shall  enter  it  shall  be  for  the  good  of  the  sick  to  the 
utmost  of  my  power.  That  whatever  I  shall  see  or 
hear  of  the  lives  of  men  and  women,  whether  they  be 
my  patients  or  members  of  their  households,  that  will 
I  hold  inviolably  secret  and  that  I  will  continue  to 
observe  and  to  study  and  will  strive  in  every  way  for 
the  improvement  of  my  profession;  not  regarding  it 
as  a  means  of  livelihood  alone,  but  as  an  honorable 
and  upright  calling." 

To  be  loyal,  to  be  honorable,  to  be  just,  to  be  gen- 
erous, to  be  pure,  to  be  upright,  to  be  trustworthy  and 
"not  a  meddler  in  other  men's  matters,"  to  be  ob- 
servant, to  be  tactful,  to  be  studious,  all  these  are  prin- 
ciples which,  if  they  do  not  already  possess  them,  should 
be  instilled  into  the  minds  of  all  young  women  from 
the  day  they  enter  the  training  school  until  they  leave  it. 
All  are  links  of  grave  import  in  the  chain  of  "qualifica- 
tions of  a  good  nurse"  as  well  as  stepping-stones 
toward  becoming  "a  perfect  woman  nobly  planned." 


8 


Bacteriology  in  a  Nutshell. 


CHAPTER  I. 

BRIEF    HISTORY   OF    BACTERIOLOGY. 

Bacteriology  is  that  branch  of  science  which 
teaches  us  the  evils  of  disease  producing  micro-  Definition. 
organisms,  and  the  benefits  derived  by  the  ani- 
mal world  from  another  class  which  are  antag- 
onistic to  disease. 

The  history  of  bacteriology  can  be  traced 
back  to  the  seventeenth  century.  Some  au- 
thorities, indeed,  tell  us  that  at  as  early  a  date 
as  the  time  of  Caesar,  116-27  B.  C,  there  lived  Earliest 
a  Roman  author,  Varro  by  name,  who  wrote  of 
very  tiny  living  "creatures"  which  were  invis- 
ible to  the  naked  eye,  and  yet  they  by  some 
means  gained  an  entrance  into  the  system  and 
"caused  diseases  difficult  to  treat."  Almost 
two  thousand  years  roll  by  before  we  learn  of 
the  germ  theory  of  disease  being  again  touched 
upon,  then,  in  the  eighteenth  century,  it  is  ad- 
vocated by  Plenciz,  of  Vienna. 

In  the  year  1675  we  are  tQld  that  Antonius 
Von   Leeuwenhoek,   of   Holland,*  proclaimed  Perfection 
to  the  world  the  perfection  of  his  single  lens  by  |?n  le  Lens 
means  of  which  he  had  brought  to  light  "living, 
moving  animalcules"  in  rainwater.     So  very 

*  Leeuwenhoek   was  born   in   Delft,    Netherlands,   in. 
1632;  died  in  1723. 

9 


BACTERIOLOGY  IN  A  NUTSHELL. 


Leeuwenhoek's 
Announcement. 


Theory 

of 

Plenciz. 


tiny  were  these  objects  that  millions  of  them 
were  found  to  exist  in  a  single  drop. 

The  researches  of  Leeuwenhoek  were  con- 
tinued and  in  1683  the  world  received  another 
announcement — the  discovery  under  the  com- 
pound microscope  of  a  special  form  of  bacteria 
in  the  scrapings  of  teeth  and  in  saliva.  This 
scientist  presented  the  results  of  his  work  of 
research  to  the  *  Royal  Society  of  London, 
England;  suitable  engravings  accompanied 
the  gift.  We  are  not  told  whether  or  not 
Leeuwenhoek  in  any  way  connected  the  germs 
he  discovered  with  disease  causation;  the  sup- 
position of  authorities  is  that  he  did  not. 

No  attempt  was  made  to  classify,  separate 
or  identify  the  germs  discovered  by  Leeuwen- 
hoek, although  many  noted  scientists  of  that 
century  believed  them  to  be  the  cause  of  certain 
changes  in  the  tissues  of  the  human  structure. 
It  was  not  until  the  year  1762  that  Antonius 
Plenciz,  a  physician  of  Vienna,  began  ascrib- 
ing to  the  micro-organisms  discovered  by 
Leeuwenhoek  the  power  to  produce  the  so- 
called  infectious  diseases. 

The  theories  advanced  by  Plenciz  were  these : 

I. — That  the  material  which  caused  the  in- 
fection was  a  living  substance ; 

II. — That  this  living  substance  multiplied 

*  Leeuwenhoek  was  chosen  Fellow  of  the  Royal  So- 
ciety of  London  in  1685. 

10 


BRIEF    HISTORY    OF    BACTERIOLOGY. 

within  the  system,  and  that  it  could  be  thrown 
off  by  individuals  and  carried  by  the  air  to 
others ; 

III. — That  each  separate  infectious  disease 
was  brought  into  existence  by  a  special  germ 
which  could  cause  no  other  disease ;  contending, 
in  order  to  uphold  his  belief,  that  as  only  one 
kind  of  grain  can  grow  from  one  kind  of  seed, 
so  also  only  one  disease  can  be  produced  by 
one  form  of  germ  or  micro-organism. 

The  theory  that  disease  germs  were  living 
things  capable  of  growth  and  reproduction  did 
not,  at  this  time,  gain  favorable  consideration, 
and  it  is  not  again  advanced  until  almost  sixty 
years  have  elapsed.  In  the  year  1821,  *Henle, 
an  anatomist  and  scientist  of  Germany,  again 
gave  expression  to  the  conviction  of  the  truth- 
fulness of  the  theory,  but  only  to  be  met  with 
the  opposition  which  defeated  Plenciz.  Henle, 
however,  is  said  to  have  successfully  met  and 
overcome  all  the  objections  of  his  opponents, 
and  shortly  after  this  time  the  relation  of  micro- 
organisms to  disease  was  scientifically  proven  Theory8 
although  many  still  remained  sceptical.  Accepted. 

One  point  over  which  there  was  a  great  deal 
of  discussion  during  the  century  and  a  half 
between  the  discoveries  of  Leeuwenhoek  and 


*  F.  Gustav  Henle,  born  at  Furth,  Bavaria,  1798 ;  died 
at  Gottingen,  1885.  Was  professor  at  Zurich,  1824; 
Heidelburg,  1844,  and  at  Gottingen,  1852. 


ii 


BACTERIOLOGY  IN   A  NUTSHELL. 

the  acceptance  of  the  theories  of  Plenciz 
through  the  demonstrations  of  Henle,  was  the 
origin  of  these  germs.  "Do  they  generate 
spontaneously  or  are  they  the  descendants  of 
pre-existing  creatures  of  the  same  kind? 
Theory  of  *Karl  H.  Schulze,  also  of  Germany,  was  the 

first  to  throw  any  light  on  this  rather  mystify- 
ing question.  In  1836  he  demonstrated  the 
fact  that  "if  the  air  which  gained  access  to  the 
material  which  was  being  experimented  upon 
could  be  made  to  pass  through  strong  acid  or 
alkaline  solutions  decomposition  would  not  take 
place."  Other  scientists  began  to  work  along 
the  same  lines  and  obtained  similar  results. 
Their  experiments,  for  the  most  part,  were 
made  upon  wounds  and  their  infections.  They 
made  no  attempt  to  reproduce  the  infectious 
diseases  by  inoculation,  which  is  the  method 
used  in  our  day.  Numbers  of  scientific  men  of 
that  period  believed  the  presence  of  micro- 
organisms in  the  blood  and  tissues  of  individ- 
uals to  be  a  normal  condition.  Others  urged 
that  the  micro-organisms  found  in  diseased 
conditions  were  the  result  of  the  disease  and  not 
its  cause. 

A  number  of  years  passed  before  the  work  of 
discovering  a  special  germ  for  each  infectious 
disease  made  much  progress. 

*  Karl  Heinrich  Schulze,  physician  and  anatomist, 
born  at  Ault,  Ruppin,  in  1798.  Professor  at  Berlin 
in  1833-  I2 


BRIEF    HISTORY    OF    BACTERIOLOGY. 

In  1847  Ignatius  P.  Semmelweis,  a  young 
Hungarian  pursuing  his  studies  in  Vienna,  pro-  Ploclamation 
claimed  to  the  world  one  of  the  greatest  dis-  Semmelweis. 
coveries  ever  made  along  bacteriological  lines, 
namely,  that  puerperal  sepsis  is  the  result  of 
the  invasion  of  the  puerperal  genital  tract  by 
specific  micro-organisms  and  from  that  year 
a  new  era  in  obstetrical  practice  is  dated. 

Semmelweis,  among  other  medical  students, 
was  allowed  to  assist  at  births  in  the  maternity 
wards  of  a  large  general  hospital  where  there 
were  also  a  number  of  midwives  employed. 
Semmelweis  soon  observed  that  a  large  mor- 
tality, about  fifteen  per  cent  (15%)  occurred 
in  the  student's  clinic,  and  almost  invariably 
from  puerperal  fever.  In  the  clinics  in  charge 
of  the  midwives  the  mortality  rate  was  very 
low  in  comparison,  only  about  1.5  per  cent. 
He  began  to  study  into  the  reason  for  the 
greater  success  of  the  midwives.  He  soon  had 
cause  to  suspect  that  the  dissecting-room  work 
of  the  students  was  at  the  root  of  the  trouble. 
One  of  his  fellow-students  died  from  the  effects 
of  an  infected  finger,  which  he  had  cut  during 
a  post-mortem.  The  symptoms  in  this  case 
were  so  similar  to  those  observed  in  the  deaths 
due  to  puerperal  fever  in  the  maternity  wards 
that  Semmelweis's  eyes  were  opened  to  the 
dangerous  practice  of  the  students  who  often 
went  directly  from  the  dissecting-room  to  their 
13 


BACTERIOLOGY  IN  A  NUTSHELL. 

cases  in  the  maternity  wards,  with  little 
thought,  apparently,  as  to  the  condition  of 
their  hands.  Semmelweiss  immediately  began 
to  scrub  and  disinfect  his  own  hands  before  ap- 
proaching the  beds  of  his  maternity  cases,  and 
soon  found  his  efforts  crowned  with  success. 
Then  he  insisted  upon  his  fellow-students 
practicing  the  same  routine.  The  mortality 
rate  in  the  students'  clinic  thereafter  became 
much  less  than  that  of  the  midwives.  The  dis- 
infectant used  by  Semmelweis  and  his  co- 
workers  was  chlorine  solution.  In  spite  of  the 
success  of  this  conscientious  worker,  there  was 
much  scepticism  with  regard  to  his  theory,  and 
he  died  in  an  insane  asylum,  his  malady  the  re- 
sult of  worry  over  unfriendly  criticism. 

In  1849  the  germ  which  causes  anthrax  was 
discovered  by  Pollender,  of  Germany,  but  it 
was  not  until  the  year  1863  that  *Casimir 
Joseph  Devaine,  a  Frenchman,  by  the  process 
of  inoculation  proved  that  Pollender 's  germ 
really  produced  anthrax. 

In  1862  *  Louis  Pasteur,  of  France,  the  fame 
of  whose  work  at  "Pasteur  Institute,"  Paris,  is 
world  wide,  first  began  his  experiments  to 
prove  that  living  organisms  are  in  the  air  we 
breathe,  in  the  food  we  eat,  upon  the  clothing 

*  Casimir  Joseph   Devaine,  born  at   St.  Armand-les- 
Eaux,  France,  in  1812;  died  in  1882. 

*  Pasteur  was  born  at  Dole,  Jura,  France,  in  1822 ; 
died  in  1895. 

14 


BRIEF    HISTORY    OF    BACTERIOLOGY. 

we  wear,  in  the  dust  we  tread  beneath  our  feet, 
and  that  they  may  be  found  any  place  where 
dust  settles.  It  had  long  been  contended  that 
the  processes  of  fermentation  and  putrefaction 
were  purely  chemical  processes  and  not  the 
work  of  micro-organisms.  It  was  proven  also 
through  the  experiments  of  Pasteur  that  the 
reproduction  of  bacteria  takes  place  by  pro- 
cesses similar  to  those  which  cause  the  repro- 
duction of  larger  vegetable  or  plant  life  and  not 
by  spontaneous  generation.  Many  other  im- 
portant discoveries  are  credited  to  the  experi- 
ments of  Pasteur.  In  fact,  some  scientific  men 
of  the  present  day  go  so  far  as  to  say  that  the 
real  history  of  bacteriology  dates  no  further 
back  than  to  the  experiments  and  discoveries  of 
Pasteur ;  that  while  it  was  not  he  who  first  dis- 
covered the  existence  of  germ  life,  nor  who  first 
studied  bacteria,  nor  who  first  suggested  their 
connection  with  fermentative  processes  and 
with  diseases,  yet  it  is  to  his  experiments  we 
owe  the  placing  of  bacteriological  study  upon  a 
firm  basis,  and  that  all  the  history  of  micro-  Lessened  by 
organisms  which  antedates  the  experiments  and 
discoveries  of  Pasteur  is  merely  theoretical, 
more  likely  to  be  erroneous  than  otherwise. 

In  1872  Klebs  began  to  teach  that  general 
sepsis  is  caused  by  bacteria  invading  the  blood. 
Klebs  is  of  German  birth;  he  was  born  in 


BACTERIOLOGY  IN  A  NUTSHELL. 

Koenigsberg;  he  was  educated  at  Berlin,  and 
later  in  life  ( 1882-92)  was  professor  at  Zurich. 

In  1873  tne  micro-organism  of  relapsing 
fever  was  discovered.  To  Obermeier,  of  Gei- 
many,  belongs  the  credit  for  this  discovery. 

In  1875  the  germ  theory  of  disease  was 
Antise  ^is  pretty  generally  accepted,  at  least  by  the  scien- 

tific world.  In  that  year  Lord  Lister,  an 
English  surgeon,  who  later  (1877)  was  pro- 
fessor in  King's  College,  London,  began  the 
use  of  antiseptics  in  surgery.  He  based  his 
experiments  upon  the  discoveries  of  Pasteur. 
Carbolic  acid  solution  was  the  first  substance 
used  by  Lister  in  his  surgical  operations,  and 
thus  was  ushered  in  the  era  of  antiseptic;  surg- 
ery. Only  thirty-two  years  have  passed,  and 
yet  to  what  gigantic  proportions  has  grown  the 
use  of  substances  to  either  destroy  germs  or  to 
prevent  their  doing  mischief  by  stopping  their 
growth!  Carbolic  acid  solutions  still  remain 
in  common  use. 

The  bacillus  of  leprosy,*  the  bacillus  leprac, 
was  discovered  by  a  German  scientist,  Hanson, 
in  1879,  and  in  the  same  year  the  micro-coccus 
of  gonorrhoea  by  Neisser.  (Neisser  is  also  of 


*  In  July,  1904,  Rost,  of  the  medical  staff  in  India, 
reported  that  he  had  succeeded  in  cultivating  the 
bacillus  of  leprosy  and  from  the  cultures  had  made 
a  substance  he  called  "leprolin,"  which,  when  injected 
into  the  tissues  of  lepers,  had  a  marked  beneficial  effect. 

16 


BRIEF    HISTORY    OF    BACTERIOLOGY. 

German  birth,  probably  located  at  Munich  at  Later 
this  time.) 

The  bacillus  typhosus,  the  germ  of  typhoid 
fever,  was  discovered  by  Eberth  and  Koch,  of 
German,  in  1880. 

And  in  that  year  (1880)  came  also  the  dis- 
covery of  the  germ  of  pneumonia.  Some 
writers  give  the  credit  (or  discredit)  for  causing 
this  disease  to  the  micro-organism  observed  by 
General  Sternberg*  of  the  United  States 
Army;  others  to  the  diplococcus  lanceolatus, 
discovered  by  *Frsenkel  of  Berlin,  who  was 
professor  at  Halle.  Recent  investigation  has 
shown  that  the  diplococcus  discovered  by 
Frsenkel  is  probably  the  sole  cause  of  genuine 
acute,  lobar  pneumonia,  although  other  germs, 
one  of  which  is  the  "pneumo-bacillus  of  Fried- 
lander,"  are  said  to  be  sometimes  found  asso- 
ciated with  this  form  of  the  disease.  Several 
germs  are  believed  to  be  capable  of  causing 
broncho-pneumonia. 

In  1882  the  name  of  Robert  Koch*  sprang 

into  fame  when  he  made  the  greatest  of  his  Kpch's 

Discoveries. 

many  discoveries — the  germ  which  is  the  cause 

*  Authorities  assert  that  the  germ  observed  by  Stern- 
berg  and  the  diplococcus  lanceolatus  are  probably  iden- 
tical.    Fraenkel   associated   the   germ  with   pneumonia 
causation;  Sternberg  apparently  did  not. 

*  Koch,  born   at   Klausthal,   Germany,   in   1843.     Led 
the   German   expedition  which   in    1883   went  to   Egypt 
and   India  to   investigate  cholera.     In    1890  announced 
a  cure  for  tuberculosis,  the  power  of  which  experience 
did  not  demonstrate. 

17 


BACTERIOLOGY  IN  A  NUTSHELL. 

of  all  forms  of  tuberculosis.  This  discovery  is 
not  only  to  be  considered  the  greatest  of  Koch's 
discoveries,  but  one  of  the  greatest  discoveries 
of  the  age,  as  to  tuberculosis,  in  one  or  another 
of  its  forms,  is  due  at  least  one-sixth  of  all  the 
deaths  which  occur  yearly  in  the  human  family. 
Had  the  remedy  for  this  disease,  prepared  by 
Koch,  proven  a  success,  he  would  have  im- 
mortalized his  name  in  very  deed. 

In  1884  Koch  made  another  discovery, 
namely,  the  comma  bacillus  of  cholera;  so- 
called  because  of  its  peculiar  shape.  (Pasteur 
p  discovered  the  germ  of  chicken  cholera  in 

of  Other  1880.)  In  1884,  also,  the  germ  of  diphtheria, 

ltlsts*  called  the  bacillus  diphtherise,  was  discovered 

by  Loeffler,  and  the  bacillus  of  tetanus,  called 
the  bacillus  tetani,  by  Nicolaier. 

The  germ  which  causes  "la  grippe"  was  dis- 
covered in  1892  by  Pfeiffer.  Loeffler.  Nico- 
laier, PfefTer,  are  all  of  German  nationality. 
(Leudwig  Pfeiffer,  born  at  Eisenach  in  1842, 
lives  at  Weimar. ) 

In  1894  came  the  discovery  of  the  bacillus 
pestis,  the  germ  of  the  Eastern  bubonic  plague 
by  Yersin,  of  France,  who  was  at  this  time  pur- 
suing his  scientific  investigations  in  China. 

Kitasato,  a  Japanese,  working  independently 

of    Yersin,    during    an    epidemic    of    bubonic 

plague  in  Hongkong  in  1893-4,  discovered  the 

same  germ  and  the  result  of  their  researches 

18 


BRIEF    HISTORY    OF    BACTERIOLOGY. 

was  proclaimed  to  the  world  almost  simultan- 
eously. 

In  1897,  the  discovery  of  the  bacillus  of  yel- 
low fever  was  reported  by  Sanarelli,  a 
Spaniard.  This  germ  was  not  accepted  be- 
cause it  failed  to  comply  with  certain  requisite 
scientific  tests.  (Koch's  circuit,  spoken  of  in 
chapter  IV,  was  not  proven.)  The  same  is 
said  of  the  germ  found  in  carcinomatous  speci- 
mens, and  of  the  germ  of  small-pox  reported 
by  Dr.  William  T.  Councilman,  of  Harvard 
College,  in  the  spring  of  1904.  It  is  now 
definitely  known  that  the  spirochetae  pallidae, 
discovered  by  Hoffman  and  Schaudinn,  of  Ger- 
many, in  1905,  is  the  germ  of  syphilis.  New 
methods  of  staining  cultures  used  in  1906-07 
by  these  and  other  scientists  working  independ- 
ently have  brought  to  light  the  true  relation- 
ship which  this  germ  (hitherto  considered 
doubtful),  bears  to  the  loathsome  disease, 
syphilis,  the  micro-organism  of  which  has  for 
so  many  years  remained  a  mystery  to  the  med- 
ical profession  and  to  other  scientific  workers. 
Authorities  in  both  Europe  and  the  United 
States  are  now  satisfied  as  to  the  authenticity  of 
the  spirochetae  pallidae.  The  germs  which 
cause  many  of  our  most  common  cummunic- 
able  diseases  still  continue  to  be  undiscovered. 
We  are  in  the  dark  as  to  what  parasite  is  re- 
sponsible for  small-pox,  scarlet  fever,  measles, 
19 


BACTERIOLOGY  IN  A  NUTSHELL. 

chicken-pox,  etc.  Rheumatism  and  arthritis 
deformans  are  believed  by  some  authorities  to 
be  germ  diseases,  but  as  yet  this  theory  has 
not  been  proven,  although  an  antistreptoccic 
serum  is  in  use  in  some  parts  of  the  United 
States  which  is  said  to  be  helpful  in  both  of 
these  incurable  diseases. 

SUMMARY  OF   CHAPTER  I. 

The  earliest  days  of  bacteriology  said  to  be 
traceable  to  the  time  of  Caesar,  in  whose  day  a 
Roman  writer  hinted  at  the  invasion  of  the 
human  structure  by  "creatures"  invisible  to  the 
naked  eye  and  of  their  power  to  produce  dis- 
eases. 

The  perfection  of  the  single  lens.  Nation- 
ality of  the  perfector.  Discoveries  of  this 
scientist  during  the  seventeenth  century  under 
the  single  lens  and  by  means  of  the  compound 
microscope.  The  presentation  of  the  results 
of  his  researches  together  with  appropriate  en- 
gravings to  the  Royal  Society  of  London, 
England,  of  which  society  he  was  afterward 
Fellow. 

Power  to  produce  the  so-called  infectious 
diseases  ascribed  to  micro-organisms  by  a 
scientist  of  Vienna.  Theories  advanced  by  this 
scientist.  Non-acceptance  of  his  theories: 

The  germ  theory  of  disease  again  advanced 

20 


REVIEW. 

about  sixty  years  later  and  its  successful  demon- 
stration. 

A  short  account  of  one  of  the  subjects  which 
caused  much  discussion  during  the  century  and 
a  half  between  the  discoveries  of  the  Hollander 
and  the  acceptance  of  the  theory  of  the  scientist 
of  Vienna. 

The  man  who  first  threw  light  upon  the 
mystery  surrounding  this  vexed  question  and 
the  manner  in  which  he  carried  on  his  experi- 
ments. Work  and  its  results  along  the  same 
lines  by  other  scientific  men  of  that  period. 

Errors  of  some  of  the  early  students  of  bac- 
teriology. 

Slow  progress  in  discovering  a  special  germ 
for  each  infectious  disease. 

Men  who  are  considered  to  have  made  the 
most  valuable  contributions  to  bacteriology  and 
their  discoveries. 

QUESTIONS  FOR  REVIEW. 

I. — Who  perfected  the  "single  lens"  and 
what  were  the  first  discoveries  made  by  its  per- 
fector?  In  what  year  did  he  announce  his 
discoveries  ?  Are  these  the  earliest  discoveries 
of  which  we  have  any  account  ? 

II. — In  what  year  were  later  discoveries  an- 
nounced by  this  scientist?     How  were  these 
discoveries  made  ?     To  whom  were  the  results 
of  his  researches  presented  ? 
21 


BACTERIOLOGY  IN  A  NUTSHELL. 

III. — What  attempts  were  made  to  classify, 
separate  and  identify  the  germs  discovered,  and 
were  they  believed  to  be  in  any  way  connected 
with  pathological  changes  in  any  particular 
part  of  the  body  ? 

IV. — Who  was  -the  first  physician  to  ascribe 
to  micro-organisms  the  power  to  produce  the 
so-called  infectious  diseases?  In  what  year 
was  the  announcement  made  ?  Was  the  theory 
accepted  ? 

V. — Who  is  said  to  have  been  the  first  to 
successfully  demonstrate  that  the  germs  dis- 
covered in  the  seventeenth  century  could  pro- 
duce diseases? 

VI. — Describe  in  detail  one  of  the  chief 
points  of  discussion  during  the  years  that 
elapsed  between  the  discoveries  mentioned  and 
their  acceptance  as  disease  germs.  Tell  of  the 
man  who  first  threw  a  gleam  of  light  on  the 
vexed  question,  of  the  means  used,  of  others 
who  followed  the  same  method  of  research,  the 
results  gained. 

VII. — Mention  some  of  the  errors  of  early 
students  of  bacteriology  with  regard  to  the 
germ  theory  of  disease.  To  whom  do  some 
bacteriologists  ascribe  most  credit  for  the  firm 
basis  of  this  theory  in  the  present  day? 

VIII. — By  whom  and  in  what  years  were 
antiseptics  first  used?  In  what  class  of  cases 

22 


REVIEW. 

were  they  used?  What  were  the  first  sub- 
stances used?  Are  they  still  in  use  and  are 
they  now  considered  valuable  antiseptics? 

IX. — By  whom  and  in  what  year  was  it  first 
taught  that  bacterial  invasion  is  the  cause  of 
puerperal  sepsis ?  What  became  of  this  scientist? 
Who  first  taught  the  theory  of  general  sepsis? 

X. — By  whom  was  the  germ  of  typhoid  fever 
discovered?  In  what  year  was  the  discovery 
made  ?  Mention  other  discoveries  made  by  one 
of  these  men?  Which  is  considered  to  be  the 
most  important  of  his  discoveries  and  why  ? 

XL — Name  some  of  the  important  dis- 
coveries made  during  later  years  and  their  dis- 
coverers. 

XII. — Mention  some  diseases  now  consid- 
ered to  be  caused  by  bacteria  and  explain  why 
the  germs  discovered  in  one  or  two  instances 
have  not  been  accepted  as  the  originators  of 
the  trouble. 


CHAPTER  II. 


Revelations 
of  the 
Microscope. 


Cell 
Formation. 


Organs  and 
System. 


THE  RELATION  OF   BACTERIA  TO  DISEASE BAC- 
TERIA IN  PROCESSES  OF  NATURE. 

Mysteries  concerning  the  origin  of  numerous 
diseases,  which  must  otherwise  have  remained 
mysteries  forever,  have  been  made  more  or  less 
clear  since  the  perfecting  of  the  microscope. 
Prior  to  the  revelations  made  by  the  use  of  this 
instrument,  very  little  was  positively  known 
concerning  the  formation  of  the  various  ele- 
ments of  which  the  machinery  of  the  human 
structure  is  made  up  and  by  which  it  is  kept 
in  running  order.  Now  scientists  are  able  to 
trace  the  human  body  back  to  the  time  when  it 
was  but  a  single  cell,  from  this  single  cell  to 
watch  its  growth  and  development  into  in- 
numberable  single  cells,  to  see  the  single  cells 
fold  into  layers,  these  in  their  turn  to  form  the 
groups  of  cells  out  of  which  the  various  bones 
and  muscles  and  nerves  and  tubes  and  tissues 
of  the  body  are  composed.  These  groups  we 
call  the  organs  and  systems  of  the  body.  Each 
has  its  own  work  to  perform,  and  each  exists 
to  a  certain  extent  independently  of  the  other. 
Yet  all  are  so  intimately  related  and  connected 
in  their  efforts  to  maintain  life  and  health  that 
\vhen  disease  comes  to  one  group  of  cells 
24 


BACTERIA  AND  DISEASE. 

posing  a  system,  other  groups  composing  other 
systems  suffer  also. 

The  group  of  cells  from  which  the  muscular 

Action  of 
system  is  made  up,  by  their  united  action,  called  Various  Cells. 

into  play  by  nerves,  produce  our  movements. 
Another  group  of  cells  forms  the  liver  and  har- 
monious action  of  this  group  is  necessary  in 
order  that  impurities  be  removed  from  the 
blood.  Certain  fluids  which  are  essential  to  the 
welfare  of  the  body  are  also  manufactured  by 
this  group.  The  brain  is  composed  of  another 
group  of  cells  of  a  different  type;  from  these 
thought  and  intelligence  emanate,  and  from  still  Nerve  Cells, 
another  group  is  composed  the  nerves  which 
convey  messages  to  and  fro  between  the  brain 
and  the  outer  world  and  so  on.  When  these 
various  groups  are  all  "in  tune"  then  the  human 
body  is  in  a  state  of  health,  when  they  are  "out 
of  tune,"  we  speak  of  the  body  as  in  a  state  of 
disease.  In  a  state  of  disease  our  work  is  no 
longer  a  pleasure  to  us ;  our  hours  of  recreation 
are  no  longer  a  joy.  Our  days  are  filled  with 
discomfort  and  our  nights  are  robbed  of  rest 
and  sweet  sleep. 

As  nurses,  then,  let  us  grasp  this  thought  that 
"disease  is  a  derangement  of  the  structures  or 
functions  of  the  body,"  and  in  order  that  the  011  °£ 

human  structure  remain  healthy,  there  must  be 
harmonious  action  between  separate  types  or 
groups  of  cells.     If  one  group  fails  to  work 
25 


BACTERIOLOGY  IN  A  NUTSHELL. 

harmoniously,  then  comes  a  disturbance  of  the 
harmony  of  the  other  groups,  and  because  of 
this  disturbance  there  comes  disease.  For  ex- 
ample :  If  there  is  trouble  in  the  nervous  system, 
then,  too,  we  find  the  digestive  system  is 
affected,  and  vice  versa.  So  we  may  go  on 
through  the  other  systems  and  find  them  all 
more  or  less  dependent  one  upon  another. 

The  causes  of  disease  are  many  and  varied. 
One  of  the  most  serious  causes,  as  revealed  by 
scientific  research,  is  the  invasion  of  the  differ- 
Bacteria  a  ent  organs  ancj  systems  of  the  human  structure 

Disease.  by  a   species  of  bacteria;  these   it  has  been 

proven  produce  many  of  the  so-called  infectious 
diseases.  Bacteriological  research  tends  to  the 
belief  that  certain  forms  of  moulds  and  pro- 
tozoa— the  simplest  form  of  animal  life,  and 
one  which  is  distinguished  from  all  other 
animal  groups  because  it  consists  of  but  a  single 
cell — are  also  causes  of  some  of  the  "infectious 
diseases."  So  much  has  been  said  and  written 
,  on  "the  relation  of  bacteria  to  disease"  that 

many  people  fail  to  discriminate  between  the 
bacteria  which  are  our  friends  and  those  which 
are  our  enemies. 

As  pupils  in  the  study  of  bacteriology  we 
learn  that  the  term  bacteria  is  applied  by  scien- 
tists to  the  large  group  of  minute  vegetable 
micro-organisms,  commonly  called  "germs"  or 
"microbes."  This  name  was  first  given  to 
26 


BACTERIA  AND  DISEASE. 

them  about  the  year  1869,  after  *  Hoffman  had  Bacteria 
demonstrated  that  these  tiny  mysteries  occu-  Explained, 
pied  a  class  by  themselves,  quite  distinct  from 
yeast  plants  and  moulds  with  which  they  had 
been  confused  in  earlier  days  of  bacteriological 
research.     For  years  scientists  had  been  unable 

to  decide  as  to  whether  bacteria  were  members  M 

.      Animals  or 
of  the  plant  family,  or  whether  they  were  the  plants. 

offspring  of  animal  life,  for  the  reason  that 
they  were  found  to  possess  characteristics  of 
both  families  or  kingdoms.  When  it  was  dis- 
covered under  the  microscope  that  some  of  the 
bacteria  are  spore-forming,  their  classification 
as  members  of  the  plant  or  vegetable  kingdom 
was  determined.  Absence  of  chlorophyl,  the 
name  given  to  the  green  coloring  matter  of 
plants,  caused  doubt  to  arise  in  the  minds  of 
many;  chlorophyl  is  the  property  in  plant  life, 
which  enables  them  to  cause  decomposition  of 
carbon  dioxide  and  ammonia  and  to  consume 
as  food  their  products.  Bacteria,  lacking  this 
property,  feed  upon  the  same  forms  of  food  as 
the  higher  animals  consume. 

All  forms  of  bacteria  may  be  divided  into 
two  great  classes  in  order  to  simplify  for  study.  Saprophytic 
These  two  classes  are  called  the  saprophytes, 
and  the  parasites.     The  saprophytes,  which  are 
the  friends  of  all  animal  life,  are  many  times 

*  Hoffman   was   a   German  botanist.     Born   at   Roe- 
delsheim,  1819;  died  at  Giessen,  1891. 

27 


BACTERIOLOGY  IN   A  NUTSHELL. 

more  numerous  than  the  parasites.  Parasites 
are  enemies  to  animal  life;  they  are  the  so- 
called  "disease  germs"  or  "microbes" ;  they 
exist  only  at  the  expense  of  other  living  bodies. 
They  invade  various  parts  of  the  living  body 
and  under  favorable  conditions  they  weaken 
and  sometimes  destroy  the  parts  they  invade. 
They  take  away  from  us  substances  on  which 
our  health  is  dependent,  and  deposit  in  their 
place  that  which  poisons  and  frequently  com- 
pletely destroys.  Because  of  their  power  to 
produce  pathological  changes  in  animal  bodies, 
parasitic  bacteria  are  also  called  pathogenic 
bacteria. 

Saprophytic  bacteria  are  not  only  our  friends, 
but  they  are  of  such  benefit  to  mankind  that  we 
could  not  live  without  them.  They  live  upon 
dead  organic  matter,  and  by  their  activities  de- 
composition, fermentation  and  putrefaction  are 
produced.  Nourishment  necessary  to  the  sus- 
tenance of  vegetable  life  is  derived  from  car- 
bonic acid  gas,  ammonia  and  water,  which  are 
all  produced  by  the  action  of  saprophytic 
bacteria  on  dead  animals  and  vegetables.  Veg- 
etable and  plant  life  would  cease  to  exist  if  the 
carbon  and  nitrogen  to  which  they  owe  their 
growth  and  development  could  not  be  obtained 
from  this  source.  Animal  life  is  sustained  by 
the  oxygen  thrown  off  by  trees  and  plants  and 
to  a  certain  extent  by  the  food  obtained  from 
28 


BACTERIA  IN   PROCESS  OF  NATURE. 

the  vegetable  world  ;  therefore,  the  work  of  the 
saprophytes  is  necessary  to  the  existence  of  all 
forms  of  life. 

With  regard  to  the  work  of  saprophytes  as 
our  friends  in  the  processes  of  Nature,  let  us  Bacteria  in 
look  a  little  farther  into  this  phase  as  explained  presses 
to  us  by  scientists.     Let  us  see  why  it  is  that 
they  play  so  important  a  part  in  these  processes, 
and  how  it  is  that  they  are  so  completely  inter- 
woven with  the  vital  powers  of  nature,  that  life 
in  all  its  forms  would  vanish  from  the  earth 
should  their  activities  cease. 

When  as  children  we  explored  the  woods  and 
perched  ourselves  upon  fallen  tree  trunks  and  Decay  of  Trees 
saw  them  dropping  into  decay,  how  many  of  us  a  ants' 
now  studying  bacteria  in  regard  to  their  con- 
nection with  our  work  as  nurses  ever  associated 
the  process  of  decay  with  the  activities  of 
germs?  Today  we  are  taught  that  bacteria 
play  an  important  part  in  this  process  after  the 
hard,  woody  substance  of  the  tree  has  been 
softened  and  prepared  for  their  work  by 
moulds.  Then,  after  the  tree  has  been  attacked 
by  bacteria,  it  drops  to  pieces  as  a  yellowish 
brown  deposit,  to  mix  with  dead  leaves  and 
sink  into  the  soil  as  a  fertilizer  to  promote  the 
growth  of  healthy  plants  and  trees  that  inhabit 
the  forest. 

The  same  thing  happens  in  decay  of  dead 


plants  and  animals.     In  decomposition  of  ani- 
29 


BACTERIOLOGY  IN  A  NUTSHELL. 

mals  saprophytes  play  a  still  more  important 
part,  as  it  is  by  their  agency  alone  that  the  work 
on  every  part  of  such  bodies  is  accomplished, 
and  the  preparation  made  for  mixing  with  the 
soil  and  the  atmosphere.  Whatever  of  the  de- 
cayed substance  of  tree  and  plant  and  animal 
is  not  of  use  as  a  fertilizer  is  disseminated  in 
the  form  of  gases  to  be  taken  up  by  the  air,  to 
be  returned  to  the  elements  from  which  they 
came  again  to  be  used  in  the  formation  of 
something  else  in  the  various  processes  of 
Nature.  So  plant  and  vegetable  and  animal 
life  are  renewed  and  sustained  in  a  great 
measure  through  the  fertilization  of  the  soil 
by  decomposition  of  dead  plants  and  vegetables 
and  animals,  and  by  the  gases  they  disseminate, 
none  of  which  would  come  to  pass  without  the 
activities  of  bacteria. 

We   inhale   from   the   atmosphere   oxygen, 

Where  which  is  absolutely  necessary  for  the  sustenance 

Obtained*8  °^  an^ma^  ^e,  and  which  is  thrown  off  for  our 

use  from  growing  plants  and  trees  and  other 

forms  of  vegetable  life.     We  exhale  carbonic 

acid  gas,  or  "carbon  dioxide,"  which,  together 

with  the  influences  of  the  sun  and  the  rain,  is 

necessary  for  the  growth  and  sustenance  of 

trees  and  plants  and  vegetables.  This  is  one  way, 

among  others,  in  which  the  animal  kingdom  is 

necessary  to  the  vegetable  kingdom  and  vice 

versa,  the  plant  and  vegetable  world  giving  off 

30 


SUMMARY    AND    REVIEW. 

oxygen  for  use  of  the  animal  world,  and  the 
animal  world  in  its  turn  supplying  the  plant 
and  vegetable  world  with  carbon  dioxide  in  a 
ceaseless  round.  All  other  foods  used  to  sus- 
tain animal  and  plant  life  are  so  arranged  by 

„  _*  ,    Nature  in 

the  processes  of  Nature  as  to  be  used  again  and  pood  Supply. 

again  in  a  continuous  circle,  first  by  plants  and 
then  by  animals,  and  then  over  again  by  plants, 
the  circle  to  endure  so  long  as  the  sun  shines 
and  the  rain  falls  to  promote  its  continuance. 
Many  of  these  processes  require  much  thought 
in  order  to  understand  the  intricate  workings 
of  Nature.  Those  who  undertake  the  study 
in  earnest  find  it  of  special  interest.  Not  the 
least  interesting  phase  is  the  way  in  which 
nitrogenous  foods,  so  necessary  to  animal  life, 
take  their  place  in  the  continuous  circle,  and 
how,  through  the  assistance  of  bacteria  they 
are  prepared  to  return  to  take  part  in  the  main- 
tenance of  plant  and  vegetable  life. 

Bacteria  which  assist  in  the  sprouting  of 
seeds  and  in  other  processes  of  Nature  in  farm 
and  garden,  form  an  interesting  study,  also. 

SUMMARY  OF   CHAPTER  II. 

Mysteries  with  regard  to  diseases  revealed 
by  the  miscroscope. 

Cell  formation  and  the  formation  of  the  or- 
gans and  systems. 

31 


BACTERIOLOGY  IN  A  NUTSHELL. 

Health  of  the  various  organs  and  systems  of 
the  body  dependent  one  upon  another. 

Functions  of  some  of  the  groups  of  cells. 

Derangement  of  the  structure  and  its  func- 
tions the  cause  of  diseases. 

Bacteria  as  friends  and  as  enemies. 

Application  of  the  term  bacteria. 

Length  of  time  the  term  has  been  in  use  and 
the  scientist  who  first  distinguished  the  group 
from  yeasts  and  moulds.  His  nationality. 

Difference  in  size  of  the  saprophytic  and 
parasitic  families. 

What  we  understand  by  the  term  pathogenic 
bacteria. 

Saprophytic  bacteria  and  the  benefits  derived 
from  them  by  the  animal  and  the  vegetable 
kingdoms. 

QUESTIONS   FOR  REVIEW. CHAPTER  II. 

I. — How  has  the  perfecting  of  the  microscope 
been  of  benefit  to  mankind  in  a  special  way  ? 

II. — Give  in  detail  some  of  the  mysteries 
with  regard  to  the  human  structure  as  revealed 
by  the  microscope  since  its  perfection. 

III. — Are  the  different  systems  of  the  body 
in  any  sense  independent  systems?  Give  one 
reason  why  they  are  not  entirely  independent. 

IV. — Mention  the  functions  of  the  groups  of 
cells  spoken  of  in  this  chapter. 

32 


SUMMARY   AND    REVIEW. 

V. — Explain  what  you  understand  by  the 
term  "disease"  and  give  the  cause  of  one 
serious  form  of  disease. 

VI. — Into  how  many  classes  may  bacteria  be 
divided  in  order  to  simplify  for  study? 

VII. — Define  bacteria,  pathogenic  bacteria, 
saprophytic  bacteria. 

VIII. — Prove  that  pathogenic  bacteria  are 
foes  to  health. 

IX. — In  what  way  do  saprophytes  benefit 
mankind  ? 

X. — Explain  what  would  happen  to  plant 
and  vegetable  and  animal  life  if  saprophytic 
bacteria  should  be  destroyed  or  become  inac- 
tive? Give  reasons  for  your  answer? 


33 


CHAPTER  III. 


Morphology 
Defined. 


Micro-cocci. 


Bacilli. 


DESCRIPTION    OF    THE    MOST    IMPORTANT    BAC- 
TERIA, METHODS  OF  MULTIPLICATION,  ETC. 

MORPHOLOGY  is  that  branch  of  science  which 
treats  of  the  classification  of  bacteria  with  re- 
gard to  their  shape,  outline,  structure  and  their 
methods  of  grouping.  Placed  in  broth, 
bouillon  or  other  substance  they  are  cultivated, 
and  much  useful  information  has  been  gained 
with  regard  to  the  habits,  etc.,  of  these  tiny 
specimens  of  vegetable  life. 

It  has  been  found  by  studying  them  under 
the  microscope,  that  all  bacteria  of  any  import- 
ance are  either  "sphere,"  "rod,"  or  "spiral" 
shaped,  and  so  they  are  divided  into  these 
three  classes. 

The   spherical   may  be  perfectly 

41         round  like  a  ball  or  marble,  or  they 

0      ^     may  be  oval  or  egg-like;  they  vary 

0  in  size  and  many  are  imperfect  in 

Spheres.  . 

shape.     The    name  -  given    to    all 
bacteria  of  this  formation  is  "cocci,"  or  "mi- 


crococci. 


Rods. 


The  rod-shaped  may  be  long  or 
short,  square  or  round  at  the  ends, 
thick  or  thin,  but  all  bear  the  com- 
mon name  of  "bacilli."  The  larg- 
est number  of  disease  germs  are 


of  this  class. 


34 


MORPHOLOGY. 

The  spiral-shaped  somewhat 
resemble  the  twisted  part  of  a  Spirilla, 
corkscrew,  and  whether  they  have 
few  or  many  curves,  whether 
loosely  or  tightly  twisted,  the  one 
name,  "spirilla,"  covers  all  of  this 

Spirals. 

variety. 

Modifications  or  subdivisions  of  the  cocci 
have  also  been  determined  by  watching  their 
manner  of  forming  into  groups  as  seen  in  grow- 
ing cultures. 

Staphylococci  is  the  term  used  to  describe 
those    which    group    in    masses    like    grape-  Staphylococci. 
clusters. 

Streptococci,  to  describe  those  with  method  04. 

Streptococci. 

of  grouping  into  chain-like  sections. 

Other  forms  of  the  micrococci  are  found  to 
group  in  pairs,  and  to  describe  these  the  term 
diplococci  is  used. 

Those  which  form  into  groups  of  four  are 
11    j  ^         j  Tetrads. 

called  tetrads. 

Still  another  form  is  seen  to  make  up  groups 
of  eight  and  sixteen,  and  to  describe  these  we  Sarcinae. 
use  the  term  sarcinae. 

There  are  two  main  subdivisions  of  the 
bacilli,  namely ;  bacilli  which  are  spore-forming, 
and  bacilli  which  are  non-spore-forming.  By 
the  term  spores  we  mean  seeds  or  eggs  of  the 
bacilli. 

All  forms  of  bacteria  are  dependent  upon 
35 


BACTERIOLOGY  IN  A  NUTSHELL. 


Food. 


Temperature. 


Size  of 
Bacteria. 


certain  conditions  for  their  development ;  these 
conditions  are  a  certain  temperature  and  food 
proper  soil,  and  in  some  instances  air. 

Pathogenic  bacteria  require  organic  matter 
to  feed  upon.  Vegetable  or  animal  matter, 
fluid  or  solid,  fresh  or  decayed,  all  kinds  are 
adapted  to  their  use  as  food,  but  the  blood  and 
juices  of  the  animal  body  tissues  are  specially 
favorable  material  for  their  growth  and  de- 
velopment. 

The  temperature  of  the  human  body,  viz., 
98.6°  F.,  is  the  most  favorable  for  the  multi- 
plication of  pathogenic  bacteria,  although  they 
will  also  multiply  quite  rapidly  in  a  lower 
temperature;  70°  F.  (ordinary  summer  heat) 
is  sufficiently  high.  Below  70°  F.  their  growth 
is  slower  and  has  been  found  to  cease  at  60° 
F.  A  temperature  of  110°  F.  is  believed  by 
many  to  prevent  their  growth. 

Size  of  bacteria  is  a  part  of  their  description 
difficult  to  determine.  So  tiny  are  they  that  it 
is  only  under  the  highest  power  of  the  micro- 
scope that  scientists  are  able  to  study  them  at 
all.  One  of  the  largest  of  the  bacilli  is  said  to 
be  about  1-12,000  of  an  inch  in  length,  and 
1,50,000  of  an  inch  in  thickness.  We  are  told 
that  it  would  take  six  thousand  billions  of  the 
average  sized  bacilli  to  weigh  one  grain,  and 
that  fifteen  hundred  of  the  largest  bacilli  if 
placed  end  to  end  would  not  reach  across  a 


MORPHOLOGY. 

small  pin  head.  Some  forms  of  bacteria  move 
about  quickly,  through  flagella,  an  appendage 
which  is  lash-like  in  appearance  and  by  means 
of  which  they  are  made  to  resemble  a  form  of 
animal  life.  Other  bacteria  are  very  slow  in 
their  movements. 

Weigert*  in  the  year  1877  discovered  that 

micro-organisms  could  be  colored  by  the  use  of  Weigert's 

Discovery. 
aniline  dyes,  so  as  to  be  distinguished  from  the 

media  in  which  they  are  cultivated.  Up  to  that 
time  great  difficulties  stood  in  the  way  of  their 
successful  study,  because  of  their  transparency 
as  well  as  their  minuteness.  Since  Weigert's 
discovery  that  they  can  be  colored,  many  of  the 
peculiarities  by  which  their  varieties  are  deter- 
mined have  been  pointed  out. 

We  have  said  that  one  condition  necessary  to 
the  growth  and  development  of  bacteria  is 
proper  soil.  A  perfectly  healthy  body  with 
normal  resistive  power  is  not  favorable  soil  for 
the  development  of  disease  germs.  In  such  a 
body  certain  cells  exist  which  are  foes  to  these 
germs ;  they  have  the  power  either  to  absorb  or 
destroy  disease-producing  bacteria.  These 
cells  are  found  in  the  white  corpuscles  of  the 
blood,  the  leucocytes,  and  are  called  pha- 
gocytes; the  process  of  destruction  or  absorp- 
tion is  known  as  phagocytosis.  The  name 

*  Professor  Carl  Weigert,  anatomist  at  Frankfort, 
Germany. 

37 


BACTERIOLOGY  IN  A  NUTSHELL. 

Function  of  phagocytes  (from  the  Gk.  phago  "I  eat")  was 

Phagocytes.  /    .  „    ,      .,  '          A.      } 

given  to  these  cells  by  the  man  who  discovered 

their  province,  the  scientist,  *Elie  Metchnikoft", 
a  Russian,  one  of  the  most  distinguished  bac- 
teriologists of  the  present  day  and  who  is 
carrying  on  his  work  at  Pasteur  Institute, 
Paris,  France,  as  successor  to  Pasteur.  While 
scientists  differ  as  to  the  method  of  warfare  as 
carried  on  between,  the  cells  of  the  body, 
termed  phagocytes,  and  the  germs  of  disease, 
all  agree  that  the  healthy  body  has  the  power 
to  overcome  and  exterminate  such  foes  by  their 
means.  Scientists  who  are  not  associated  with 
the  school  of  Metchnikoff,  teach  us  that  there 
are  properties  contained  in  the  serum  of  the 
blood  known  as  opsonins,  discovered  by  Sir 
Almoth  Wright,  of  England,  which  assist  the 
phagocytes  very  materially  in  their  work. 
They  prepare  the  pathogenic  bacteria  in  some 
unexplained  manner,  making  them  more  readily 
digested  and  absorbed  and  then  attract  them 
toward  the  phagocytes. 

The  body  which  is  not  healthy,  and  in  which 
normal  resistive  power  is  absent,  on  the  other 
hand  is  not  able  successfully  to  fight  disease- 
producing  germs  which  invade  it  at  one  point 
or  another,  they  overcome  weakened  resistive 
forces,  increase  and  multiply  within  the  body, 

*  Metchnikoff     was     born     in     the     government     of 
Kharkoff  in  1845.    Was  professor  at  Odessa  in   1870. 
38 


MORPHOLOGY. 

and  we  become  victims  of  the  disease  the  special 
form  of  bacteria  present  produces. 

There  are  two  methods  of  multiplication  in 
the  bacterial  world — fission  and  spore  forma- 
tion. 

The  method  by  which  micro-cocci  and 
spirilla  multiply  is  termed  fission;  fission  in  Fission, 
common  everyday  language  means  simply  di- 
vision. They  rapidly  separate  or  divide  into 
a  number  of  sections,  each  of  which  soon  leaves 
the  parent  cell,  and  in  turn  divides  into  other 
sections  or  parts.  The  micro-cocci  before 
fission  takes  place  elongate  or  lengthen  out, 
they  then  divide  in  the  center,  each  half  again 
divides  and  these  new  sections  also  repeat  the 
process  again,  and  again.  In  many  instances 
they  divide  at  right  angles  to  the  first  division 
and  again  at  right  angles,  forming  in  this  man- 
ner the  groups  of  two,  four,  eight  and  sixteen, 
which  have  been  mentioned  as  the  "diplococci" 
"tetrads"  and  "sarcinae."  Those  which  upon 
division  do  not  immediately  become  detached 
one  from  the  other,  but  which  form  into  chain- 
like  sections  have  also  been  described  as  bear- 
ing the  name  of  "streptococci."  Others  again 
that  remain  grouped  in  clusters,  we  have 
learned  are  called  the  "staphlo-cocci."  The 
process  of  division  and  subdivision  is  kept  up 
as  long  as  the  germs  have  proper  soil  to  exist 


39 


Bacilli 
Method  of 
Multiplication. 


Spore 

Forming 

Bacilli. 


BACTERIOLOGY  IN  A  NUTSHELL. 

upon,  and  provided,  also,  the  food  temperature, 
air  and  moisture  are  such  as  they  require. 

Bacilli  multiply  in  much  the  same  way  and 
under  conditions  similar  to  those  required  by 
the  micro-cocci  and  spirilla.  This  is  especially 
true  of  the  bacilli  which  are  non-spore-forming. 

With  regard  to  the  spore-forming  bacilli, 
when  they  can  no  longer  obtain  sufficient  or 
proper  food  or  surroundings,  they  shrivel  or 
dry  up  and  appear  to  be  dead.  They  may  keep 
up  this  semblance  for  months,  but  let  conditions 
once  more  become  favorable  for  their  develop- 
ment and  we  soon  find  they  not  only  are  not 
dead,  but  are  not  even  sleeping  merely  resting. 
Place  them  in  suitable  culture  media,  for  in- 
stance, and  immediately  they  begin  to  germi- 
nate and  produce  innumerable  micro-organisms 
of  the  same  variety  as  those  from  which  they 
sprang.  They  do  not  reproduce  other  spores 
at  once,  but  never  fail  to  reproduce  that  char- 
acteristic variety  of  bacillus  which  is  spore- 
forming.  Fortunately  for  the  human  family 
the  number  of  spore- forming  bacteria  is  small, 
and  not  one  is  known  to  be  instrumental  in 
producing  a  pestilential,  epidemic  disease. 

There  are  certain  changes  which  take  place 
in  the  bacilli  when  the  process  of  seed  or  spore 
development  is  about  to  begin.  Spores,  or 
seeds,  are  made  up  of  tiny  particles  of  the 
protoplasm  or  active,  life-giving  substance  of 
40 


MORPHOLOGY. 

which  bacilli  are  composed.  They  form  some- 
times at  one  end  of  the  rod,  sometimes  at  the  Spore 

r  .       1      Formation, 

other  end,  and  again  they  may  form  in  the 

center  of  the  rod.  They  at  first  appear  to  be 
just  tiny  spots,  or  dots  in  the  protoplasm  of 
the  parent  bacillus,  but  very  soon  they  begin 
to  divide  off  and  are  easily  distinguished  under 
the  microscope  as  tiny  seeds  or  eggs  which 
scientists  call  "spores."  They  rapidly  increase 
in  size  and  break  through  the  framework  of  the 
bacillus,  the  non-essential  part  of  which  usually 
dies  and  the  seeds  or  spores  are  left  behind  in  a 
protecting  cover  or  capsule.  This  cover  or 
capsule  is  said  to  enable  spores  to  resist  in- 
fluences that  would  very  quickly  destroy  other 

forms  of  bacteria.     The  power  possessed  by  _ 

/    Resistive 
spores  to  resist  heat  and  drying  is  found  to  be  Power  of 

almost  incredible.  Bacteriologists  assert  that  sP°res- 
some  forms  of  spores  live  on  after  they  have 
been  exposed  for  a  brief  period  to  a  tempera- 
ture of  360°  F.  Other  forms  have  been  treated 
to  a  bath  of  boiling  water  for  a  longer  period, 
and  yet  both  have  come  through  these  processes 
alive  and  have  again  germinated. 

While  the  parent  bacillus,  as  a  rule,  is  sup- 
posed to  die  during  spore  formation,  because 
the  spores  use  up  the  protoplasm  of  the  parent 
for  their  own  sustenance,  this  is  believed  not  to 
be  true  in  every  instance.  The  functions  of  the 
parent  cell  are  said  sometimes  to  go  on  in  the 
41 


BACTERIOLOGY  IN  A  NUTSHELL. 

usual  way  during  the  process  of  spore-forma- 
tion, sufficient  of  its  protoplasm  being  retained 
to  sustain  life  and  again  to  renew  its  activities 
after  the  spores  have  broken  through  its  walls. 

SUMMARY  OF  CHAPTER  III. 

Classification  with  regard  to  shape,  out- 
line, etc. 

Definitions  of  various  names  descriptive  of 
bacteria. 

Methods  of  grouping  as  seen  in  growing 
cultures. 

Terms  used  to  designate  methods  of  group- 
ing. 

Bacteria  which  form  spores  and  those  which 
do  not. 

Development  of  bacteria  dependent  upon 
certain  conditions. 

Why  it  is  difficult  to  determine  dimensions 
of  bacteria. 

Discovery  of  Weigert. 

Power  of  phagocytes  and  opsinins. 

The  discoverers  of  phagocytes  and  opsinins. 

Why  bacteria  sometimes  conquer  the  phago- 
cytes. 

Methods  whereby  bacteria  multiply. 

Process  of  spore-formation. 

Wonderful  resistive  power  of  spores. 

Parent  bacillus  after  the  process  of  spore- 
formation. 

442 


SUMMARY    AND    REVIEW. 
QUESTIONS  FOR  REVIEW  ON  CHAPTER  III. 

I. — Why  is  the  study  of  morphology  im- 
portant, and  how  is  it  best  facilitated  ? 

II. — Describe  each  of  the  three  forms  of  bac- 
teria. Which  of  these  is  most  common? 

III. — Is  the  process  of  multiplication  of  bac- 
teria rapid  ?  If  so,  in  what  manner  and  under 
what  conditions  are  they  propagated? 

IV. — Are  pure  blood  and  healthy  tissue  con- 
ducive to  the  development  of  the  various  kinds 
of  bacteria? 

V. — Which  method  of  antagonizing  disease 
germs  appeals  to  you — resistance  by  a  vigorous 
healthy  body,  or  their  destruction  by  the  use  of 
powerful  drugs? 

VI. — What  is  the  meaning  of  spore-forming 
as  applied  to  bacteria? 

VII. — Are  all  varieties  of  bacteria  spore- 
forming?  About  what  is  the  size  of  the  lar- 
gest known  bacillus  ? 

VIII. — -In  what  manner  do  micro-cocci  and 
spirilla  mutiply?  Give  term  applied  and  its 
meaning. 

IX. — Are  spores  easily  exterminated  ?  What 
can  you  say  of  their  peculiar  resistive  powers  ? 

X. — Does  the  parent  bacillus  remain  vigor- 
ous after  propagating  its  kind  ? 


43 


CHAPTER  IV. 

DISEASES     CAUSED     BY     BACTERIAL     INVASION. 

HOW    BACTERIA   GAIN    AN    ENTRANCE 

TO  THE  SYSTEM. 

Parkes,  in  his  "Manual  of  Hygiene  and  Pub- 
lic Health,"  gives  the  following  table  of  dis- 
eases due  to  the  invasion  of  the  human  struc- 
ture by  bacteria.  He  divides  these  diseases 
into  five  classes,  viz. : 


CLASS  I. 

Smallpox, 

Influenza, 

Scarlet  Fever, 

Relapsing  Fever, 

Measles, 

Diphtheria, 

Mumps, 

Erysipelas, 

Chicken-pox, 

Typhus, 

Whooping  Cough, 

Epidemic  Pneumonia. 

CLASS  II. 

Yellow  Fever,  Dysentery, 

Cholera,  Diarrhoea. 

Enteric  (Typhoid)  Fever, 

CLASS  III. 

Anthrax  or  Malignant  Pustule,   Vaccinia, 
Foot  and  Mouth  Disease,  Ophthalmia, 

Leprosy,  Syphilis, 

Glanders,  Gonorrhoea, 

Rabies,  Tetanus. 

CLASS  IV. 

Erysipelas,  Hospital  Gangrene, 

Septicaemia,  Puerperal  Fever. 

CLASS  V. 

Tuberculosis,  including  Lupus  and  Scrofula. 
44 


PARKE'S  LIST,  ETC. 

I. — Diseases  placed  in  class  one  are  desig- 
nated as  air-borne,  or,  in  other  words,  diseases 
which  may  be  carried  and  communicated  by 
floating  dust. 

II. — It  is  claimed  that  diseases  placed  in 
class  two  may  be  carried  and  communicated 
by  floating  dust  or  taken  into  the  system  in 
water.  The  "air  or  zvater  borne"  diseases, 
so-called. 

III. — Inoculation,  as  a  rule,  is  the  means  of 
communication  of  diseases  mentioned  in  class 
three. 

IV. — A  surface  lesion  is  said  to  be  necessary 
for  the  communication  of  diseases  in  class  four. 
When  this  lesion  is  present  the  disease  is  com- 
municable by  direct  inoculation  or  may  be 
transmitted  through  the  air.  (By  "lesion"  we 
mean  a  wound,  hurt,  or  other  local  alteration 
of  tissue  from  a  higher  to  a  lower  condition.) 

V. — In  class  five  a  surface  lesion  is  not  neces- 
sary and  the  disease  is  communicable  either  by 
direct  inoculation  or  through  the  air. 

It  must  be  borne  in  mind,  however,  that 
authorities  differ  as  to  the  mode  of  entrance  Authorities 
of  some  of  the  bacteria  and  that  theories  change  Differ- 
as  new  light  is  thrown  on  the  subject.     The 
science   of  bacteriology   is   still   rapidly  pro- 
gressing. 

The  alimentary  canal,  the  respiratory  tract, 
the    genital    tract,    the    mucous    membranes, 
45 


Channels  of 
Entrance. 


Period  of 
Incubation. 


Why 

Multiplication 

Ceases. 


BACTERIOLOGY  IN  A  NUTSHELL. 

wounds  and  the  skin,  all  form  channels  where- 
by infection  is  conveyed  to  the  various  parts 
of  the  body  which  are  seats  of  attack  for 
pathogenic  bacteria. 

An  incubation  period,  which  varies  in  dura- 
tion, is  common  to  all  forms  of  disease  caused 
by  the  invasion  of  bacteria.  During  the  incu- 
bation period  there  are  no  symptoms  of  the 
disease.  The  germs  have  gained  admission 
to  the  body  by  one  or  other  channel  of  entrance 
and  a  war  is  being  waged  between  the  invaders 
and  the  antagonistic  cells  already  spoken  of  as 
phagocytes  and  opsinius.  Under  favorable 
circumstances  the  invaders  do  no  harm,  they 
are  destroyed  by  their  foes  and  are  thrown  off 
from  the  body  in  the  excretions.  If  the  powers 
of  resistance  are  weakened  in  any  way,  by  the 
presence  of  any  other  disease,  for  instance, 
the  influence  of  the  phagocytes  is  lost  and  the 
period  of  incubation  ends  in  another  period 
wherein  the  power  of  the  invading  bacteria  is 
made  manifest  and  symptoms  arise  followed  by 
more  or  less  serious  results. 

In  each  specific  disease  the  infection  is 
thrown  off  from  that  part  of  the  body  which  is 
the  seat  of  the  invasion. 

During  the  course  of  a  communicable  or 

specific  disease  there  comes  a  time  when  there 

is  no  longer  any  suitable  nourishment  for  the 

growth  and  development  of  the  micro-organ- 

46 


NATURAL  IMMUNITY. 

isms  and  then  the  disease  is  starved  out. 
Sometimes  the  action  of  the  germs  upon  the 
cells  of  the  body  produces  a  condition  which  is 
poisonous  to  the  germs  themselves  and  thus 
they  are  destroyed  by  the  products  of  their  own 
vital  activities.  In  either  case  the  tissues  are 
left  in  a  state  of  immunity  from  that  particular  Immunity, 
disease  for  a  longer  or  shorter  period,  some- 
times for  life.  We  are  told  of  three  forms  of 
immunity. 

I. — Natural  immunity,  which  is  the  natural 
and  constant  resistance  of  the  antagonistic  cells  Natural 
or  phagocytes  to  the  development  within  the    mmumty- 
body  of  pathogenic  bacteria. 

II. — Acquired  immunity,  which  is  that  im- 
munity given  to  the  body,  or  which  the  body  Acquired 
gains,  by  a  single  attack  of  a  certain  com- 
municable disease. 

III. — Artificial  immunity,  which  is  that  im- 

.,  -11111       Artificial 

munity    given    to,    or    gained    by    the    body,  immunity. 

through  the  use  of  antitoxins. 

NATURAL  IMMUNITY. 

Let  us  look  into  the  subject  of  natural  im- 
munity and  the  part  played  therein  by  several 
allies  to  the  phagocytes. 

First,  let  us  consider  the  protection  afforded 
the  healthy  human  body  by  its  inner  arid  outer 
surfaces. 

47 


BACTERIOLOGY  IN  A  NUTSHELL. 

We  have  said  in  another  chapter  that  bac- 
teria exist  everywhere.  Our  skin,  finger-nails, 
hair  follicles,  etc.,  all  harbor  them.  Their 
numbers  are  limited  only  by  the  cleanliness  of 
the  individual  and  even  on  the  surface  of  the 
bodies  of  the  most  cleanly  the  existence  of  some 
pathogenic  bacteria  is  a  normal  condition. 

It  has  long  been  an  open  question  whether 
or  not  micro-organisms  found  upon  the  skin 
can  gain  admission,  find  their  harmful  camping 
ground  and  bring  about  diseases  unless  the  skin 
has  a  broken  surface,  or  is  in  some  way  in jured. 
In  some  instances  it  has  been  proven  that  in- 
jury or  abrasion  is  not  always  necessary  in 
order  that  germs  of  disease  penetrate  the  skin 
and  do  us  harm.  Entrance  through  an  abso- 
lutely unbroken  skin  is  a  rare  occurrence,  how- 
ever, and  then  it  is  believed  that  the  portal  of 
entry  is  either  through  the  openings  of  the 
sweat  glands  or  the  hair  follicles.  When  in- 
vasion takes  place,  we  find  as  a  result  that  such 
troubles  as  pustules,  boils,  carbuncles,  etc., 
caused  by  pus-forming  bacteria  arise.  As  a 
rule,  while  the  sebaceous  glands,  which  are  the 
appendages  of  the  hair  follicles,  do  not  secrete 
germicides,  the  perspiration  is  of  an  acid 
nature,  believed  to  be  slightly  germicidal  and 
it  also  contains  salts  which  cause  it  to  be  an 
enemy  not  easily  overcome  by  certain  forms  of 


NATURAL  IMMUNITY. 

disease  germs.     The  unbroken  skin  does  not 
absorb  bacterial  toxins. 

Subcutaneous  connective  tissue  sometimes 
forms  a  formidable  barrier  to  the  entrance  of 
pathogenic  or  disease  germs  even  after  they 
penetrate  the  skin,  although  there  are  excep- 
tions to  this  rule,  also,  as  there  are  exceptions 
to  all  general  rules. 

The  mucous  membranes  by  reason  of  their 
moist  condition  favor  the  growth  and  develop-  Mucous 
ment  of  a  number  of  bacteria ;  yet,  by  a  certain 
mechanical  process,  these  are  constantly  ex- 
creted and  removed  without  causing  the  per- 
fectly healthy  any  harmful  result. 

Certain  conditions  of  the  conjunctiva  favor 
the  entrance  of  harmful  germs,  yet  the  con-  The 
stant  mechanical  action  of  the  eyebrows,  the  Conjunctiva. 
eyelids,  the  eyelashes,  the  tear  irrigation  of  the 
surface  of  the  conjunctiva  and  the  germicidal 
power  of  the  tear  salts ;  the  rapidity  with  which 
the  conjunctival  epithelium  is  found  to  bring 
about  the  process  of  repair,  all  of  these  agents 
tend  to  protect  this   surface  from   infection, 
healthful  conditions  being  equal. 

While  it  is  true  that  the  cavity  of  the  nose 
is  a  common  ground  for  the  camping  of  such  The 
germs  as  the  staphylococci,  the  streptococci,      ose* 
the  bacillus  of  diphtheria,  etc.,  they  are  for  the 
most  part  held  in  abeyance  owing  to  the  filter- 
ing action  of  the  small  hairs  on  the  inner  sur- 

49 


BACTERIOLOGY  IN  A  NUTSHELL. 

face  of  the  nose  which  are  kept  in  motion  as 
we  breath  in  the  bacteria-laden  air.  The 
curves  in  the  nasal  cavity  also  catch  dust  laden 
with  bacteria  and  deposit  it  in  the  moist  sur- 
face of  its  walls  where  it  is  imbedded  in  mucous 
and  thrown  off  by  the  nose  blowing  process,  if 
our  bodies  are  in  a  normal  condition. 

Thirty  or  more  different  micro-organisms 

The  are  said  to  be  normally  present  in  the  mouth; 

among  these  are  found  some  that  are  patho- 
genic. The  diplococcus  pneumonia  and  the 
diphtheria  bacillus  are  among  the  number. 
Yet  in  a  condition  of  healthfulness  these  are 
expelled  through  the  action  of  the  saliva  and 
the  desquamating  of  the  epidermis  due  to  the 
process  of  mastication.  While  saliva  is  not  a 
germicide,  we  are  taught  that  it  exerts  some 
influence  over  disease-producing  germs  where- 
by their  growth  and  virulence  are  lessened. 
In  the  passage  of  disease  germs  to  the  vital 

The  portions  of  the  lungs,  we  have  seen  that  the 

surfaces  of  the  nose  and  mouth  play  an  im- 
portant part  in  reducing  their  harmfulness. 
The  surfaces  of  the  walls  of  the  bronchi  also 
serve  as  an  impediment  to  their  progress. 
Here  they  are  imbedded  in  a  coating  of  mucous 
to  be,  as  a  general  rule,  coughed  up  and  ex- 
pectorated unless  the  system  is  in  a  condition 
to  favor  the  development  of  bronchitis,  pneu- 


NATURAL  IMMUNITY. 

monia,    tuberculosis,    etc.     A    neglected    cold 
often  induces  such  conditions. 

The  hydrochloric  acid  which  the  gastric  juice 
contains  is  said  to  be  able  to  deal  a  death-blow  stomach, 
to  the  germs  of  typhoid  fever,  tuberculosis, 
cholera,  dysentery,  and  some  other  pathogenic 
micro-organisms,  when  they  reach  the  stomach 
in  food  or  water.  The  gastric  juice  is  believed 
by  some  authorities  to  render  many  disease- 
producing  germs  harmless  by  digesting  their 
poisons.  As  nurses,  we  have  learned  by  ex- 
perience that  such  germs  are  not  by  any  means 
always  destroyed  by  the  juices  which  the  sur- 
face of  the  stomach  secretes  and  expels.  They 
reach  the  intestines  when  such  powers  of  re- 
sistance are  weakened  through  our  failure  to 
take  care  of  our  health,  and  typhoid  fever, 
cholera,  dysentery,  etc.,  flourish  because  of  our 
negligence.  Bacteria  and  their  toxins  are 
often  thrown  off  from  the  stomach  in  the  pro- 
cess of  vomiting. 

The  protective  power  possessed  by  the  secre- 
tions of  the  intestinal  surfaces  is  limited.     Bile  The 
is  slightly  germicidal;  it  also  neutralizes  some  Intestmes- 
of  the  toxins.     The  pancreatic  juice  has  the 
power  to  destroy   some  of  the   products   of 
pathogenic   bacteria.     In   a    state   of   health, 
harmful  germs  are  eliminated  in  fecal  matter. 

The  protection  against  disease  germs  afforded 
the  healthy  human  body  by  the  surface  of  the 
51 


BACTERIOLOGY  IN  A  NUTSHELL, 

genito-urinary  tract,  is  due  to  the  acids  thrown 
off  from  the  vaginal  walls  and  the  irrigation 
due  to  voiding  of  urine. 

The  discovery  of  the  province  of  the  phago- 
Phago-Cytosis.  cytes  we  have  already  stated  is  due  to  the 
researches  of  Metchnikoff  of  the  Pasteur 
Institute,  Paris.  The  phagocytes  are  in  reality 
the  leucocytes  or  white  corpuscles  of  the  blood. 
Metchnikoff  was  the  first  to  discover  and 
demonstrate  and  announce  that  these  cells  of 
the  body  have  the  power  not  only  to  devour 
pathogenic  bacteria,  but  also  to  destroy  and 
digest  them  after  they  are  devoured.  Metch- 
nikoff also  asserts  that  the  leucocytes  have 
the  power  to  excrete  germicidal  substances 
into  the  plasma  and  serum  of  the  blood 
giving  to  the  serum  greater  power  as  a 
germicide  than  it  is  known  to  possess  normally. 
Metchnikoff  also  believes  that  the  phagocytes, 
the  name  he  has  given  to  the  leucocytes,  may 
also  absorb  the  poisons  or  toxins  of  pathogenic 
bacteria,  and  in  some  manner  cause  these  to 
be  harmless. 

Other  theories  concerning  substances  said 
to  be  contained  in  the  healthy  human  body, 
which  by  their  action  render  us  immune  or 
protected  from  the  inroads  of  disease  germs, 
present  difficulties  too  great  for  students  just 
beginning  to  look  into  the  science  of  bacte- 
riology, and  are  really  of  more  benefit  to 
52 


NATURAL  IMMUNITY. 

physicians  than  to  nurses.  In  our  work,  we 
only  need  such  knowledge  as  will  serve  to  help 
us  to  keep  healthy  ourselves  and  to  aid  us  in 
our  profession  as  care-takers  of  the  sick. 

With  regard  to  acquired  immunity  which 
comes  to  us  as  a  result  of  one  attack  of  a  com- 
municable disease.  It  has  already  been  stated 
that  in  some  instances  our  recovery  is  due  to 
the  death  from  starvation  of  the  germs  of  that 
disease,  for  the  reason  that  they  have  consumed 
all  the  suitable  norishment  that  existed  within 
us.  We  not  only  recover,  but  are  left  pro- 
tected (immune),  for  a  time  from  a  recurrence 
of  that  particular  disease.  Or,  instead  of  death 
arising  from  starvation,  sometimes  the  germs 
have  over-reached  themselves  in  their  work  of 
destruction  and  have  produced  within  us  a 
toxin  or  poison  which  proves  to  be  a  source  of 
death  to  themselves  and  of  protection  or  im- 
munity to  us.  In  some  diseases  we  are  im- 
mune for  years,  sometimes  for  life.  In  other 
diseases  the  state  of  being  immune  may  be  only 
short  lived.  Lasting  immunity  is  usually  af- 
forded by  one  attack  of  such  diseases  as  small- 
pox, scarlet  fever,  measles,  typhoid  fever  or 
plague.  While  in  pneumonia,  diphtheria, 
cholera,  etc.,  the  protection  afforded  us  by  one 
attack  is  often  very  brief,  and  seems  rather  to 
predispose  to  other  attacks. 

In  artificial  immunity,  Metchnikoff  teaches 
53 


BACTERIOLOGY  IN  A  NUTSHELL. 

that  when  antitoxins  are  injected  into  a  subject, 
they  stimulate  the  phagocytes  into  greater  ac- 
tivity and  also  lend  to  them  greater  power  for 
destruction  and  absorption  of  pathogenic  bac- 
teria and  of  their  toxins.  The  substance 
opsonin,  is  said  by  some  authorities  to  act  as 
an  ally  to  the  phagocytes  by  rendering  them 
easier  of  digestion  and  of  absorption.  While 
opsonin  is  always  normally  present  in  the  blood, 
it  is  now  believed  by  many  scientists  to  be 
increased  in  both  acquired  and  artificial  im- 
munity and  is  of  great  assistance  to  the  action 
of  the  phagocytes,  not  only  by  rendering  them 
easier  to  destroy,  but  by  attracting  them  toward 
their  destroyers,  the  phagocytes. 

THE  OPSONIC  THEORY. 

The  following  article,  by  L.  B.  Newell,  M. 
D.,  copied  from  the  May  (1907)  number  of 
the  North  Carolina  Medical  Journal,  gives  a 
very  clear  explanation  of  the  "Opsonic 
Theory." 

"The  immortal  Pasteur  realizing  the  im- 
mensity of  the  subject  of  the  causation  of 
disease  by  germs  and  seeing  the  effect  of  the 
use  of  vaccine  upon  smallpox,  uttered  the 
prophecy  that  the  day  would  come  when  we 
would  treat  all  bacterial  disease  by  vaccination. 

Nature  takes  ample  care  that  we  find  out 

54 


THE  OPSONIC  THEORY. 

her  secrets  only  after  an  infinity  of  work,  yet 
as  the  years  go  by  we  begin  to  realize  more  and 
more  how  prophetic  were  the  words  of 
Pasteur.  Step  by  step  biologists,  bacteriolo- 
gists, pathologists  and  therapeutists  have  been 
drawing  nearer  the  goal,  each  investigator 
profiting  by  the  errors  of  his  predecessors — 
each  coming  a  step  nearer  the  truth. 

Years  ago  Metchnikoff  promulgated  his 
theory  of  Phagocytosis.  Since  his  time  it  has 
been  known  that  when  bacteria  enter  the 
tissues  of  the  body  the  system  at  once  en- 
deavors to  combat  their  invasion  by  sending 
vast  numbers  of  white  blood  cells  to  meet  the 
enemy.  To  that  mysterious  power  of  attrac- 
tion which  exists  between  the  invading  bac- 
teria and  the  leucocytes,  or  phagocytes,  we 
have  applied  the  term  chemiotaxis.  The  pha- 
gocytes have  the  power  under  certain  circum- 
stances of  picking  up  the  microbes,  ingesting 
them  and  killing  them.  Metchnikoff,  believ- 
ing that  the  leucocytes  were  the  only  active 
elements  in  the  process  of  phagocytosis,  held 
that  the  fluid  portion  of  the  blood  was  merely 
an  indifferent  medium.  Others  taking  up  the 
work  found  that  the  serum  is  far  from  being 
inactive  or  indifferent.  They  found  that  the 
invading  bacteria  are  in  many  cases  victorious 
and  overcome  the  defensive  leucocytes.  And 
this  led  to  the  question  why  either  the  bacteria 
55 


BACTERIOLOGY  IN  A  NUTSHELL. 

on  the  one  hand  or  the  white  blood  corpuscles 
on  the  other  hand  are  not  always  victorious. 
Attempts  to  answer  this  have  given  rise  to  many 
theories  and  much  theorizing.  Over  in  one  of 
the  great  English  hospitals  there  is  a  man, 
Sir.  A.  E.  Wright,  who  has  asked  this  ques- 
tion and  has  answered  it  with  such  finality  that 
the  scientific  world  has  almost  accepted  it  as 
proved.  He  has  found  that  there  are  in  the 
blood  serum  or  plasma  certain  substances  which 
act  upon  bacteria  in  such  a  way  as  to  prepare 
them  to  be  ingested  and  destroyed  by  the 
leucocytes.  Without  this  substance  or  these 
substances  the  leucocytes  are  powerless.  To 
this  power,  substance  or  property  of  the  blood 
has  been  applied  the  term  Opsonic  derived 
from  the  Latin  word  Opsono  meaning  "I  pre- 
pare food  for"  or  "I  prepare  for  dinner."  For 
our  purposes  it  matters  little  what  the  proper- 
ties and  characteristics  of  opsonins  are.  Ap- 
parently there  is  a  different  opsonin  in  the  blood 
for  each  form  of  bacteria.  It  is  a  fact  readily 
observed  that  an  individual  often  succumbs  to 
one  infection  more  readily  than  to  another; 
likewise  the  same  individual  at  one  time  seems 
immune  to  a  certain  bacterial  disease,  at  an- 
other he  quickly  falls  a  victim  to  the  same 
affection.  According  to  our  opsonic  theory 
we  would  explain  these  facts  by  the  varying 
degree  of  opsonic  power  of  the  blood.  Instead 
56 


THE  OPSONIC  THEORY. 

of  saying  that  the  infection  is  more  virulent  or 
that  his  vital  resistance  has  been  reduced  we 
say  the  opsonic  index  is  low. 

It  is  claimed  by  the  discoverer  that  there 
actually  is  a  variation  at  different  times  in  the 
opsonic  content  of  the  blood.  In  other  words 
the  blood  of  an  individual  will  be  stronger  or 
weaker  in  opsonic  power,  or  the  blood  of  the 
sa'me  individual  will  be  at  different  times 
stronger  or  weaker  in  opsonic  power  as  regards 
each  disease  germ. 

That  the  leucocytes  are  powerless  to  fulfill 
their  function  as  phagocytes  without  the  help 
of  opsonins  is  according  to  the  advocates  of 
the  theory  entirely  established.  Without  de- 
scribing in  detail  the  methods  by  which  this 
is  proved  it  is  sufficient  to  say  that  the 
leucocytes  isolated  by  appropriate  methods  and 
mixed  with  living  germs  in  a  liquid  saline 
medium  do  not  attack  bacteria;  but  if  blood 
serum  be  added  to  the  mixture  of  leucocytes 
and  bacteria  the  phagocytic  activity  begins  at 
once.  This  undoubtedly  proves  that  the  serum 
contains  some  substance  which  enables  the  leu- 
cocytes to  attack  and  destroy  the  micro-organ- 
isms. 

Wright   has   originated    a   very    ingenious 

method  of  determining  the  opsonic  power  of 

the  blood  by  comparing  the  opsonic  potency  of 

the  blood  of  the  individual  under  observation 

57 


BACTERIOLOGY  IN  A  NUTSHELL. 

with  that  of  the  mixed  blood  of  a  number  of 
normal  persons.  The  degree  of  opsonic  power 
as>determined  by  this  method  has  been  termed 
the  opsonic  index. 

Suppose  a  patient  is  suffering  with  an  in- 
fectious disease  like  tuberculosis,  acne,  or  ulcer- 
ative  endocarditis.  In  such  conditions  why 
are  the  leucocytes  unable  to  prevail  in  their 
battle  with  the  invading  germs  ?  It  is  because 
the  opsonic  index  is  below  normal  or  those  sub- 
stances which  enable  the  leucocytes  to  fight  the 
germs  are  diminished.  The  problem  therefore 
naturally  presents  itself :  increase  the  opsonins, 
raise  the  opsonic  index  to  normal  or  above 
normal  and  the  defenders  will  prevail ! 

For  obvious  reasons  any  description  of 
laboratory  processes  in  a  paper  of  this  kind  is 
entirely  out  of  place,  but  the  practical  applica- 
tion of  this  theory  is  about  as  follows : 

An  individual  is  about  to  undergo  treatment 
for  infection  by  a  certain  germ.  His  blood  is 
tested  for  its  opsonic  index,  which  indicates 
whether  or  not  his  vital  resisting  powers  are 
above  or  below  normal.  If  below  normal  he 
is  given  a  hypodermic  injection  of  a  specially 
prepared  culture  of  the  germ  which  caused  his 
disease — the  micro-organisms  having  previ- 
ously been  rendered  harmless  by  heat.  As  a 
result  the  opsonic  power  is  at  first  diminished, 
but  this  is  invariably  followed  by  a  positive 
58 


IMMUNITY ANTITOXINS. 

increase;  this  is  repeated  at  suitable  intervals 
as  indicated  by  frequent  blood  examinations, 
the  object  being  to  keep  the  blood  serum  in  a 
condition  to  prepare  the  bacteria  for  destruc- 
tion by  the  white  blood  cells,  that  is,  in  as  high 
a  state  of  opsonic  power  as  possible. 

This  principle  is  being  put  to  very  successful 
practical  application  in  staphylococcic  infection 
of  the  skin  such  as  acne  and  boils;  in  tuber- 
culosis of  the  joints,  glands  and  even  in  con- 
sumption; empyema  due  to  presence  of  the 
pneumococcus,  ulcerative  endocarditis  caused 
by  the  streptococcus  and  in  various  other  forms 
of  specific  bacterial  diseases.  It  is  not  ap- 
plicable except  to  those  diseases  of  which  the 
specific  causative  germ  is  known. 

In  other  words  Opsonin  treatment  is  an 
attempt  to  increase  the  power  of  resistance  of 
the  body  to  attacks  by  pathogenic  organisms. 
The  results  of  bacterial  invasion  are  in  part, 
impairment  of  digestion  and  assimilative  func- 
tion, normal  metabolism  is  interfered  with,  so 
that  tissue  waste  must  be  repaired,  nutrition 
fostered  and  strength  conserved." 

ANTITOXINS  are  antidotes  to  bacterial 
poisons.  These  substances  are  obtained  by  in-  Antitoxins, 
jecting  into  the  body  of  one  of  the  lower  ani- 
mals, found  subject  to  the  disease,  poisons 
produced  by  pathogenic  bacteria  while  develop- 
59 


Protection. 


Testing. 


BACTERIOLOGY  IN  A  NUTSHELL. 

ing  in  broth,  bouillon  or  other  culture  media. 
After  the  bacteria  have  remained  in  the  culture 
media  for  a  stated  period  their  poison  per- 
meates it.  Some  of  the  bouillon  is  then  taken 
and  injected  into  the  chosen  animal  (horses, 
goats,  guinea  pigs,  rabbits,  etc.,  are  all  experi- 
mented upon.  The  horse  is  preferred  for  the 
development  of  diphtheria  antitoxin),  with  a 
special  syringe,  in  very  small  doses  at  first 
which  are  gradually  increased  until  the  animal 
ceases  to  exhibit  any  symptoms  of  the  disease, 
the  poison  of  which  has  been  used  for  the  in- 
jections. Then  he  is  said  to  be  immune  or 
protected  from  that  particular  disease.  Some 
of  the  blood  of  this  immunized  animal  is  then 
procured  and  allowed  to  coagulate  and  the  serum 
or  fluid  part  is  injected  into  other  animals  or 
into  members  of  the  human  family,  in  the  same 
way  in  which  it  was  used  in  the  first  instance, 
until  they  too  become  immune  from  that 
specific  disease  for  a  longer  or  shorter  period. 
Before  using  the  blood  serum  of  an  im- 
munized animal  on  the  human  subject  it  is 
tested  on  another  of  the  lower  animals  for  the 
purpose  of  ascertaining  its  protecting  power. 
If  it  stands  the  test,  it  is  put  up  in  small  tubes 
and  tightly  sealed  until  required  for  use. 
Diphtheria,  tuberculosis,  tetanus,  septicemia 
and  other  diseases  are  treated  by  antitoxin 
inoculations.  The  mortality  rate  in  diphtheria, 
60 


IMMUNITY ANTITOXINS. 

which,  until  the  use  of  antitoxin  used  to  be  fifty 
per  cent  and  over,   has  through  the  instru- 
mentality of  this  agent  been  reduced  to  three 
per  cent  when  used  sufficiently  early  in  the  case. 
Antitoxins  are  said  to  have  the  power  to  render  Power  of 
inert  bacteria  that  may  already  be  present  in  Antitoxins- 
the  subject  treated,  or  to  bring  about  such  alter- 
ations in  the  tissues  of  the  body  as  will  prevent 
their  development  and  a  cure  is  the  result. 

There  are  four  steps  necessary  in  the  prepar- 
tion  of  antitoxins : 

I. — The  germs  are  obtained  and  grown  in  a 
proper  substance  under  suitable  conditions  until 
the  toxin  or  poison  is  produced. 

II. — The  poison  is  introduced  in  gradually 
increased  doses  until  protection  is  obtained. 
(A  dose,  we  are  taught,  can  be  borne  toward 
the  last  of  the  treatment  which  if  given  at  first 
would  have  caused  instant  death.)  Some 
authorities  tell  us  the  process  takes  from  three 
to  six  months.  Others  give  the  period  as  from 
six  months  to  two  years. 

III. — Some  of  the  blood  of  the  immune  ani- 
mal is  next  obtained;  aseptic  precautions  are 
observed  during  its  removal.  After  coagula- 
tion the  serum  is  taken  and  its  protecting 
power  tested  on  other  lower  animals. 

IV. — It  is  put  up  in  sterile  tubes  and  care- 
fully and  aseptically  sealed,  ready  for  the  use 
of  the  human  subject. 

61 


Vaccination. 


Koch's 
Circuit. 


BACTERIOLOGY  IN  A  NUTSHELL. 

The  antitoxin  treatment  is  somewhat  similar 
in  its  effects  to  vaccination  as  a  protection 
against  small-pox.  The  theory  has  been  ad- 
vanced that  vaccination  against  diphtheria  and 
other  communicable  diseases  may  come  to  be 
an  established  method  during  epidemics. 

It  is  claimed  by  Koch  that  in  order  to  prove 
that  a  certain  germ  or  micro-organism  is  the 
cause  of  a  specific  disease  it  must  produce  cer- 
tain effects.  Briefly,  these  are  as  follows : 

I. — Where  the  disease  is  present  there  the 
specified  germ  must  always  be  found. 

II. — The  germ  found  in  the  diseased  body 
must  again  grow  and  multiply  in  proper  culture 
media  outside  of  the  body. 

III. — 'The  same  disease  must  be  reproduced 
in  a  healthy  animal  by  using  the  poison  or 
toxin  obtained  from  the  culture  media  in  which 
the  germ  has  multiplied. 

IV. — The  same  germ  must  again  be  found  in 
the  serum  of  the  blood  of  the  animal  thus  in- 
oculated as  a  result  of  the  process. 

Koch  further  states  that  it  must  be  proven 
that  no  other  germ  is  capable  of  producing  the 
disease  under  consideration  and  that  if  the 
original  micro-organism  is  not  found  all 
through  the  process  the  suspected  disease  does 
not  exist. 


62 


SUMMARY    AND    REVIEW. 
SUMMARY  OF  CHAPTER  IV. 

Parkes'  list  of  diseases  due  to  bacterial  in- 
vasion. How  they  are  communicable. 

Authorities  have  different  opinions  on  this 
point. 

Manner  in  which  bacteria  gain  an  entrance 
to  the  human  structure. 

The  periods  of  incubation,  invasion  and  de- 
velopment of  disease  if  the  bacteria  are  not 
overcome  by  the  phagocytes. 

How  infection  is  thrown  off  from  the  healthy 
body. 

Death  of  bacteria  through  lack  of  nourish- 
ment and  other  causes. 

Immunity:  Natural,  acquired,  artificial  and 
definitions. 

The  opsonic  theory. 

Antitoxins :  Where  they  are  obtained  and 
how  they  are  prepared. 

Koch's  Circuit. 

QUESTIONS  FOR  REVIEW. CHAPTER  IV. 

I. — How  are  diseases  designated  in  the 
classes  mentioned? 

II. — Define  inoculation.  Surface  lesion. 
Air-borne. 

III. — Mention  channels  through  which  in- 
fection is  communicated  to  the  body. 

63 


BACTERIOLOGY  IN  A  NUTSHELL. 

IV. — What  do  you  understand  by  "period  of 
incubation?"  "Seat  of  invasion?" 

V. — Explain  the  conditions  under  which 
symptoms  of  diseases  due  to  bacteria  arise  ? 

VI. — What  becomes  of  the  invading  germs 
if  overcome  by  the  phagocytes  ? 

VII. — How  do  bacteria  work  their  own  de- 
struction ? 

VIII. — In  what  other  way  may  their  multi- 
plication within  the  body  be  arrested,  and  their 
death  result?  Who  discovered  the  province 
of  the  opsinins? 

IX. — Describe  antitoxins  in  detail,  their  de- 
velopment and  use?  What  effects  should  be 
expected  to  follow  the  antitoxin  treatment? 

X. — What  is  Koch's  germ  theory?  De- 
scribe the  complete  circuit  in  detail. 


CHAPTER  V. 

COMMON  COMMUNICABLE  DISEASES. 

In  former  years  communicable  diseases  were 
spoken  of  as  either  contagious  or  infectious  Contagious 
diseases.  The  term  contagious  was  applied  to  infectious. 
those  diseases  which  are  transmitted  by  direct 
contact  or  inoculation;  infectious  to  those 
which  are  either  air  or  water  borne.  It  has 
been  developed  by  experience  that  many  of 
the  diseases  which  were  called  infectious  can 
also  be  transmitted  by  contact  or  inoculation 
and  also  that  those  diseases  termed  contagious 
are  sometimes  air  or  water  borne,  hence  the 
apparent  necessity  for  the  change  to  the  term 
communicable  which  is  used  to  cover  all  dis- 
eases that  may  be  transmitted  or  communicated 
from  a  sick  to  a  well  person  without  refer- 
ence to  the  method  of  transmission  or  com-, 
munication. 

Among  the  communicable  diseases  commonly  communicable 
met  with  by  the  nurse  we  will  first  mention         Diseases. 

TYPHOID     FEVER.     The     invading    micro- 
organism in  this  disease  is  the  bacillus  typhosus,  Bacillus 
discovered  by  Eberth  and  Koch  and  sometimes  Typhosus. 
called  Eberth's  bacillus  in  honor  of  one  of  its 
discoverers.     The  seat  of  invasion  in  typhoid 
fever  is  the  small  intestine  in  the  lower  part  of 
65 


BACTERIOLOGY  IN  A  NUTSHELL. 


iThe  Peyerian 
Glands. 


Changes 
Produced. 


Hemorrhage. 


Perforation 

and 

Peritonitis. 


Absorption 
of  Poison. 


what  is  known  as  the  ilium,  situated  near  the 
ileo-caecal  valve.  The  bacillus  first  attacks  cer- 
tain structures  termed  the  Peyerian  glands 
(also  termed  "Peyer's  patches,"  after  the  an- 
atomist who  first  discovered  or  described 
them).  These  glands  are  small  white  look- 
ing patches,  or  groups  of  lymph  follicles,  (tiny 
sacs  containing  great  numbers  of  small, 
round  cells  and  some  fluid)  in  the  mucous  and 
submucous  layers  of  the  lower  part  of  the  small 
and  the  beginning  of  the  large  intestine.  As  a 
result  of  the  attack,  the  Peyerian  glands  in- 
flame, swell,  thicken  and  frequently  ulcerate. 
When  ulceration  occurs  sloughing  or  casting 
off  of  dead  particles  of  tissue  follows  and  an 
open  sore  is  left  behind.  Sometimes  a  blood 
vessel  is  punctured  by  an  ulcer,  when  a  hem- 
orrhage more  or  less  severe  in  its  effect  takes 
place.  An  ulcer  may,  and  frequently  does, 
extend  through  the  entire  wall  of  the  intestine, 
when  perforation  and  the  escape  of  the  in- 
testinal contents  into  the  abdominal  cavity 
causes  peritonitis  and  death,  unless  the  perfora- 
tion is  such  as  can  be  repaired  and  the  patient 
is  in  a  condition  to  warrant  such  a  measure. 

While  the  small  intestine  is,  said  to  be  the 
chief  seat  of  the  bacterial  invasion,  the  various 
systems  of  the  human  structure  are  also 
affected.  There  is  elevation  of  temperature, 
owing  to  absorption  of  poison  produced  by  the 
66 


COMMON     COMMUNICABLE    DISEASES. 

bacillus  typhosus,  and  the  patient  frequently 
suffers  from  thirst. 

A  disordered  condition  of  the  nervous  system 
exists,  manifested  by  headache,  insomnia,  and  System™ 
in  severe  cases  by  delirium  and  unconscious- 
ness. 

The  digestive  system  is  affected  and  in  con- 
sequence we  observe  loss  of  appetite,  a  furred  The  Digestive 
tongue  and  sometimes  nausea  and  vomiting. 
At  times  there  is  a  severe  diarrhoea  present,  at 
other  times  constipation  may  exist. 

There  are  disturbances,  too,  of  the  circula- 
tory and  respiratory  systems.     The  heart  beats  The  Circula- 

.,,  .     ,  .  ..  tory  and 

more  rapidly  and  there  is  a  corresponding  in-  Respiratory 

crease  in  the  pulse  rate.     There  are  character-  Systems, 
istic  changes  in  the  respiration,  also,  very  often. 

Changes  in  the  skin  are  apparent,  and  it  is  The  Skin. 
usually  found  to  be  hot  and  dry  during  the 
height  of  the  fever. 

The  changes   in  the  muscular   system  are 
shown  by  their  thin,  flabby  condition,  which  is  Jy\ete1mUSCUlar 
especially  noticeable  if  the  disease  runs  a  pro- 
longed course. 

Changes  are  observed  in  the  urine  owing  to 
an  increase  of  the  solids  contained  therein.     It  The  Urine, 
is  highly  colored  and  diminished  in  quantity 
usually. 

The  germs  of  typhoid  fever  are  thrown  off 
in  the  evacuations  from  the  bowels,  in  the  urine,  Excretion  of 
in  vomited  matter,  in  the  dequamating  skin,  in  Germs' 
67 


BACTERIOLOGY  IN  A  NUTSHELL. 


Common 
Methods  of 
Communication. 


Contaminated 
Milk. 


Sterile 

Drinking 

Water. 


the  rose  spots,  in  pus  from  suppurative  com- 
plications, and  are  sometimes  found  in  the 
sputum  and  sordes  (foul  substance  which  col- 
lects on  the  teeth  and  gums  of  fever  patients). 
Flies  are  said  to  distribute  the  infection.  The 
common  method  of  communication  is  through 
contaminated  drinking  water  and  food  sup- 
plies. Milk  has  been  found  to  contain  the 
germs  and  they  are  said  to  multiply  rapidly 
therein.  *Milk  may  be  contaminated  ( i ) ,  be- 
cause the  cows  are  not  kept  clean;  (2),  because 
milk  pails,  cans  or  other  vessels  in  which  milk 
is  kept  are  not  thoroughly  cleansed  and  boil- 
ing water  poured  into  and  over  them  before 
using;  (3),  because  the  dairy  is  not  kept  pure 
or  persons  handling  the  milk  are  not  careful; 
(4),  because  water,  which  some  dishonest 
dealers  are  said  to  put  in  the  milk  they  sell,  may 
contain  the  germs.  Epidemics  of  the  disease 
are  common  and  are  often  traced  to  a  contam- 
inated water  supply.  Hence  the  necessity  for 
filtering  and  boiling  the  water  used  for  drink- 


*  In  the  best  dairies  and  creameries  now-a-days  the 
milk  is  Pasteurized  in  sterile  receptacles.  Water  used  to 
wash  the  butter  is  boiled  in  covered  apparatus,  and  then 
cooled  to  the  proper  temperature  in  specially  constructed 
refrigerators.  Special  care  is  taken  to  sterilize  all  cans, 
pails,  etc.,  used  for  the  milk  and  butter.  The  cows  are 
kept  clean,  and  the  milkers'  hands  and  clothing  also, 
both  in  milking  and  in  handling  the  milk  afterwards. 
Butter  made  in  these  dairies  and  creameries,  according 
to  agricultural  journals,  keeps  months  longer  than 
when  made  and  taken  care  of 'in  the  old-fashioned  way. 


COMMON    COMMUNICABLE    DISEASES. 

ing  and  in  preparing-  food,  especially  during 
epidemics.  We  cook  our  foodstuffs  to  make 
them  safe,  and  use  sterile  water  to  cleanse  fruits 
and  vegetables  which  come  to  the  table  un- 
cooked. We  keep  milk*  and  meats,  unless 
already  contaminated  when  purchased,  un- 
harmed by  placing  them  on  ice.  An  epidemic  The  Butler 
of  typhoid  fever  occurred  in  Butler,  Pennsyl-  Epidemic. 
vania,  in  1903,  the  horrors  of  which  are  still 
fresh  in  our  memories.  The  death  rate  was 
enormous.  Many  nurses  lost  their  lives.  An 
infected  water  supply  was  the  cause. 

Great  care  is  necessary  on  the  part  of  the 
nurse  who  attends  typhoid  fever  patients  to  pr°Phylaxis- 
guard  all  sources  of  infection  under  her  im- 
mediate control.  Separate  dishes  must  be  used 
for  such  patients,  and  these  must  be  kept  iso- 
lated and  cleansed  by  themselves.  They  must 
be  disinfected  each  time  after  using  by  pouring 
over  them  boiling  water,  and  they  must  be 
boiled  for  at  least  ten  minutes  once  daily  also. 
Stools  and  urine  and  vomited  matter  must  be 
thoroughly  disinfected  before  they  are  emptied. 
Use  a  sufficient  quantity  of  good  disinfectant 
solution,  boiling  water,  milk  of  lime,  carbolic 
acid,  etc.  (See  Chapter  VII  for  disinfectants), 
to  completely  saturate  the  mass.  Cover  the 

*  It  is  now  considered  much  the  safer  plan  to  use 
pasteurized  milk  for  all  purposes.  The  difference  in 
price  between  this  and  the  raw  product  is  very  small. 

69 


BACTERIOLOGY  IN   A  NUTSHELL. 

vessel  and  allow  it  to  stand  for  an  hour  before 
disposing  of  its  contents.  Thoroughly  cleanse 
and  disinfect  the  vessel  and  its  cover  each  time 
after  using  and  as  a  matter  of  precaution  keep 
a  small  quantity  of  a  disinfectant  solution  in 
all  vessels  preparatory  to  using  again.  Use  a 
separate  thermometer  for  typhoid  fever  patients 
and  also  separate  bed-pans,  urinals,  syringes 
and  rectal  tubes.  Keep  the  thermometer  in  a 
bichloride  solution,  1-1,000,  renewed  daily. 
Be  very  particular  to  cleanse  the  rectal  tubes 
and  syringes  and  boil  them  every  day.  Never 
turn  syringe  nozzles  inside  of  syringes  after 
using.  Remove  the  nozzles;  scrub  well  with 
soap  and  hot  water  before  boiling.  They 
should  be  kept  in  a  carbolic  acid  solution,  1-40, 
with  the  rectal  tubes.  This  solution  must  also 
be  prepared  anew  once  in  twenty-four  hours. 
See  that  bed  and  body  linen  and  towels  are  dis- 
infected before  placing  in  the  laundry  with  the 
ordinary  wash;  these  should  be  soaked  for  at 
least  two  hours  in  a  1-20  carbolic  acid  solution. 
Burn  all  pieces  of  old  linen  or  absorbent  cotton 
used  to  cleanse  the  mouth  and  teeth  and  lips. 
Use  listerine,  borolyptol  or  other  good  solution 
for  this  purpose.  Give  particular  attention  to 
disinfection  of  the  sick  room  at  the  close  of 
the  case  and  of  everything  it  contains. 

In  nursing  private  cases  outside  the  hospital 
The  Patient's  .  .       ,  . 

Room.  when  preparing  your  patient  s  room  ask  per- 

70 


COMMON    COMMUNICABLE    DISEASES. 

mission  to  remove  all  unnecessary  furniture  and 
draperies,  etc.,  which  may  serve  as  lurking 
places  for  germs.  Explain  when  you  ask  per- 
mission why  you  would  like  to  have  the  room 
as  nearly  on  the  hospital  order  as  possible.  If 
you  are  allowed  a  choice  of  rooms,  one  on  the 
south  side  of  the  house  is  preferable  and  as  far 
removed  from  noise  and  disturbance  as  you 
can  get  it. 

TAKE  CARE  OF  YOUR  OWN  HEALTH.  Be 
very  careful  to  thoroughly  wash  and  scrub  your  Personal 
hands  (particularly  your  nails,  beneath  which  ygiei 
are  favorite  hiding  places  for  germs),  and  dis- 
infect them  each  time  you  attend  to  the  evacua- 
tions. Never  touch  your  face  with  your  hands 
after  such  work  until  they  have  been  carefully 
cleansed  and  disinfected.  A  tiny  speck  of  any 
one  of  the  discharges  may  be  deposited  upon 
the  face  or  lips  and  gain  an  entrance  to  the 
body  with  disastrous  consequences  to  you.  Be 
watchful  of  like  dangers  when  giving  baths, 
enemas  and  in  cleansing  the  lips,  the  teeth,  the 
mouth  and  the  finger-nails  of  your  patient. 
Pay  strict  attention  to  personal  disinfection  be- 
fore going  from  a  communicable  disease  to  an- 
other case. 

Keep   your   patient's   person,   bed,   bedding 

and    room    absolutely    neat    and   clean.     Pay  General 

.  .  .  ,  ,   Precautions. 

special  attention  to  cleansing  the  mouth  and 

teeth  and  lips  between  the  hours  for  feeding 


BACTERIOLOGY  IN  A  NUTSHELL. 

and  before  administering  food  or  stimulant  or 
medicine,  as  well  as  after  the  bath,  particularly 
in  severe  cases  where  sordes  collects  so  rapidly 
on  the  teeth  and  lips.  Wipe  all  woodwork  and 
furniture  with  a  cloth  wrung  out  of  a  disin- 
fectant solution.  Pay  strict  attention  to  venti- 
lation. Remember  that  neatness  and  cleanli- 
ness are  necessities,  and  that  an  abundance  of 
fresh  air  and  sunshine  are  Nature's  own  disin- 
fectants. Two  to  three  thousand  cubic  feet  of 
fresh  air  are  required  in  all  sick  rooms;  the 
latter  amount  is  obtainable  in  a  room  fifteen  feet 
wide  by  twenty  long,  with  a  ceiling  elevation 
of  ten  feet,  but  the  current  must  be  changed 
every  hour  in  order  to  keep  the  atmosphere 
pure.  Your  patient  can  be  protected  by  a 
screen  from  her  possible  fear  of  "catching  cold" 
while  you  open  up  the  windows  from  the  bot- 
tom. They  should  be  kept  open  a  few  inches 
at  the  top  all  the  time.  All  "disease  germs" 
multiply  rapidly  in  a  room  kept  dark,  dingy  and 
badly  ventilated,  and  where  papers,  books,  and 
rubbish  are  allowed  to  accumulate.  The  sick 
one  takes  these  germs  into  the  system  again  and 
the  disease  is  both  aggravated  and  lengthened. 
*  Study  to  acquire  right  methods  of  bathing  in 

*  While  it  is  not  the  purpose  of  the  writer  to  speak 
of  methods  of  treatment  given  in  diseases  caused  by 
bacterial  invasion,  several  years  experience  in  training 
nurses  has  revealed  the  fact  that  many  pupils  fail  to 
grasp  the  proper  methods  of  applying  hydrotherapeutics 

72 


COMMON    COMMUNICABLE    DISEASES. 

this  disease.  Do  not  forget  the  importance  of 
the  cleansing  bath  using  warm  water  and  good 
soap  every  morning,  followed  by  an  "alcohol 
rub"  and  careful  powdering  of  the  back  and 
other  parts  of  the  body  where  pressure  is  ob- 
served or  friction  is  noted  due  to  contact  with 
the  mattress.  Change  your  patient's  position 
frequently  from  side  to  side  unless  the 
physician  in  charge  instructs  you  otherwise. 
This  will  not  only  be  a  comfort  to  the  sick  one, 
but  will  in  conjunction  with  the  warm  cleansing 
bath  and  alcohol  rub,  which  should  be  fre- 
quently repeated,  aid  in  the  prevention  of  bed 
sores,  the  occurrence  of  which  in  almost  all 
cases  is  due  to  lack  of  care  and  watchfulness 
on  the  part  of  the  nurse.  Turn  your  patient's 
pillows  often  and  shake  them  up  thoroughly  be- 
fore replacing  them  under  the  head.  If  the  physi- 
cian orders  ice  caps  on  the  head  and  abdomen, 


when  nursing  typhoid  fever.  If  the  physician  orders 
tub  baths,  they  seem  to  fail  to  recognize  the  necessity 
for  using  friction  systematically  in  order  to  bring  about 
the  requisite  reaction.  When  they  do  use  friction,  they 
go  about  it  in  such  a  haphazard  fashion  that  frequently 
there  is  an  increased  elevation  of  temperature  instead 
of  a  decreased,  and  the  nervous  symptoms  at  the  end 
of  the  treatment  are  more  pronounced  than  before 
beginning  it.  (This  does  not  refer  to  patients  whose 
peculiarities  of  constitution  are  such  as  to  contra- 
indicate  "tubbing,"  but  to  those  who,  when  properly 
handled,  respond  admirably).  In  giving  sponge  baths, 
also,  very  often  the  right  method  of  sponging  is 
not  observed.  It  seems  to  be  necessary  for  nurses 
who  are  training  pupils  to  pay  particular  attention  to 
practical  teaching  in  this  direction. 
73 


BACTERIOLOGY  IN  A  NUTSHELL. 

see  that  they  are  kept  filled  with  ice  and  not 
with  hot  water.  To  allow  the  ice  to  melt  and 
become  hot  water  does  more  harm  than  good. 
When  the  physician  says  "ice  caps"  he  means 
ice  caps  and  not  hot  water  bottles.  Do  not 
forget  to  keep  the  finger-nails  clean  and  the 
hair  neat,  if  the  physician  does  not  order  the 
hair  clipped. 

The  care  and  watchfulness  necessary  in 
nursing  typhoid  fever  holds  good  in  nursing  all 
germ  diseases.  It  will  therefore  be  unneces- 
sary to  speak  of  these  at  length  when  dealing 
with  other  communicable  diseases. 

A  BLOOD  TEST.  If  there  is  reasonable  doubt 
as  to  the  disease  from  which  a  patient  is  suffer- 
ing being  typhoid  fever,  a  test  discovered  by 
Widal,  of  the  University  of  Koenigsberg,  is 
sometimes  resorted  to. 

WIDAL'S  TEST  is  based  upon  the  fact  that  the 
"Widal's  blood  serum  of  a  person  who  has  typhoid  fever 

Test " 

is  antagonistic  to  the  bacillus  typhosus.  A 
drop  of  blood  is  obtained  from  the  suspected 
'patient  by  pricking  the  lobe  of  his  ear.  This 
drop  is  placed  on  a  clean  glass  slide  and  covered 
immediately  to  prevent  other  germs  which  may 
be  lurking  about  from  getting  into  it,  and  it  is 
then  allowed  to  dry.  A  little  of  the  bouillon, 
or  other  substance,  in  which  the  bacillus 
typhosus  is  being  cultivated  is  then  placed  on 
another  clean  glass  slide  and  covered.  The 
74 


COMMON    COMMUNICABLE    DISEASES. 

dried  blood  of  the  suspected  patient  is  made 
into  a  watery  solution  and  added  to  the  culture. 
From  this  mixture  of  dried  blood  and  typhoid 
bacillus,  what  is  known  as  a  "hanging-  drop" 
preparation  is  made  under  the  miscroscope. 
If  the  patient  has  typhoid  fever  the  bacilli  will 
be  seen  rapidly  to  lose  their  power  of  motion 
and  to  form  into  tangled  clumps,  or  masses, 
and  so  get  away  from  the  blood  serum  of  the 
patient.  If  typhoid  fever  does  not  exist,  this 
clumping  and  entanglement  of  the  bacilli  and 
arrest  of  their  movements  does  not  occur. 

There  is  said  to  be  an  exception  to  this  rule  in 

.     .     .        ..  Exception  to 

cases  where  the  patient  has  had  the  disease  *widal's  Test. 

recently,  under  which  circumstance  the  reac- 
tion may  occur  without  such  evidence  of  the 
onset  of  a  new  attack. 

CHOLERA  is  caused  by  Koch's  comma  bacil- 
lus.    Dysentery,  a  somewhat  similar  disease,  is  Cholera  and 

,       ,      .„  r  Dysentery. 

caused  by  the  bacillus   dysentenae — both   of 

these  diseases  are  contracted  through  the  same 
sources  as  typhoid  fever  is  contracted,  and  the 
same  watchfulness  against  its  spread  must  be. 
rigidly  carried  out;  also  the  same  precautions 
as  to  personal  cleanliness  and  neatness  with 
regard  to  the  nurse,  patient,  and  patient's  room. 
Be  especially  careful  to  let  the  pure  air  and 

*  German  authorities  spell  this  scientist's  name  Vidal, 
and   assert  that  he  is  French  and  that  the  American 
spelling,  "Widal,"   has  arisen  because   of  the  German 
pronunciation  of  the  letter  V. 
75 


Sources  of 
Infection. 


Intubation 

and 

Tracheotomy. 


BACTERIOLOGY  IN  A  NUTSHELL. 

sunshine  have  free  access  at  all  times,  and 
remember  the  danger  from  impure  water. 
Epidemics  of  cholera  from  that  source  are  not 
common  here.  An  epidemic  occurred  in  Ham- 
burg, Germany,  in  the  months  of  August  and 
September,  1892,  when  nearly  nine  thousand 
deaths  were  reported  during  the  two  months. 
The  epidemic  was  believed  to  be  due  to  the 
infection  of  the  river  from  which  that  city  ob- 
tains its  water  supply.  Gipsies  had  camped  on 
the  river  banks,  and  as  they  had  a  case  of 
cholera  in  their  midst,  the  trouble  was  thought 
to  have  arisen  from  that  source. 

DIPHTHERIA.  The  bacillus  diphtherise,  the 
micro-organism  of  diphtheria,  can  be  taken  into 
the  system  in  food.  It  may  also  be  communi- 
cated from  the  sick  to  the  well  directly  from  the 
mouth,  indirectly  through  the  infected  dishes, 
books,  toys,  spoons,  or  other  similar  articles, 
or  the  infection  may  be  breathed  in.  The 
germs  are  found  in  the  discharges  from  the 
nose  and  throat.  The  nurse  must  be  careful 
to  avoid  having  the  patient  cough  in  her  face, 
as  particles  of  membrane  dislodged  from  the 
throat  are  a  fruitful  source  of  danger,  especially 
so  to  both  physicians  and  nurses  during  opera- 
tions on  the  throat  (tracheotomy  and  intubation 
of  the  larynx),  for  the  relief  of  patients  suffer-? 
ing  from  this  dread  disease. 

While  the  seat  of  invasion  in  diphtheria  is 
76 


COMMON    COMMUNICABLE    DISEASES. 

usually  the  throat,  other  parts  of  the  body 
suffer  also,  which  is  always  the  state  of  affairs 
in  severe  germ  diseases.  A  common  sore 
throat  forms  a  good  camping  ground  for  the 
diphtheria  bacillus  and  the  deadly  work  is 
accomplished  very  rapidly  in  many  instances. 
Patients  sometimes  die  before  their  danger  is 
realized  by  the  uninitiated.  Suffocation,  heart 
failure  and  exhaustion  are  immediate  causes 
of  sudden  death.  The  nurse  must  be  ever  on 
the  alert  for  symptoms  of  approaching  danger 
from  any  of  these  sources. 

Disinfect  all  discharges  from  the  throat  and 
nose;  all  bed  linen,  towels,  handkerchiefs,  Disinfect  and 
spoons,  dishes  and  all  sick-room  utensils  with 
boiling  water,  or  with  hot  carbolic  acid  solution 
i -20.  Wipe  all  woodwork,  floors  and  walls 
with  bichloride  of  mercury  solution  1-1,000 
and  fumigate  with  formaldehyde  or  sulphur. 
Observe  carefully  the  precautions  with  regard 
to  patient  and  room,  sunshine,  ventilation  and 
disinfection  at  the  close  of  case.  Be  careful 
to  protect  your  patients  from  any  possibility 
of  drafts  striking  them.  Use  a  screen  about 
the  bed.  No  patient's  bed  should  be  so  placed 
as  to  be  in  a  current  of  air.  A  room  properly 
ventilated  is  not  "drafty"  of  necessity. 

Membranous  croup  and  whooping  cough  are  , 

Membranous 
contracted  in  the  same  way  as  diphtheria,  and  Croup  and 

are  spread  by-  the  same  means.     Moist  air  is 
77 


BACTERIOLOGY  IN  A  NUTSHELL. 

necessary  in  the  patient's  room  in  most  cases  of 
diphtheria,  whooping  cough  and  croup  to  re- 
lieve the  throat  symptoms. 


Various 
Forms. 


INFLUENZA  OR  LA  GRIPPE. 

The  bacillus  of  this  disease  finds  an  entrance 
to  the  system  through  the  respiratory  tract. 
Sources  of  infection  are  the  discharges  from 
the  throat  and  nose,  which  should  always  be 
disinfected. 

There  are  several  forms  of  "la  grippe," 
notably  the  catarrhal,  bronchial  and  intestinal 
forms.  In  the  intestinal  form,  some  physicians 
advise  disinfection  of  the  evacuations  also. 
This  is  one  of  the  few  germ  diseases  which  one 
is  apt  to  contract  very  frequently.  No  num- 
ber of  attacks  will  afford  immunity.  Epi- 
demics are  common. 


Methods  of 
Communica- 
tion. 


SCARLET    FEVER,    MEASLES,    GERMAN    MEASLES, 
CHICKEN  POX. 

The  germs  causing  scarlet  fever,  measles, 
German  measles  (Roseola)  and  chicken  pox 
are  found  in  the  secretions  from  the  nose  and 
throat  and  in  the  desquamating  (peeling  or 
flaking)  skin.  The  disease  can  be  contracted 
through  direct  contact  with  the  afflicted  person, 
articles  used  in  the  sick  room,  such  as  books, 
toys,  clothing,  food  cr  dishes,  and  also  in  the 
78 


COMMON     COMMUNICABLE    DISEASES. 

dust  and  sweepings  of  the  ward  or  room.  This 
is  especially  true  of  scarlet  fever  and  measles, 
and  the  nurse  needs  to  be  more  than  ordinarily 
cautious,  as  the  disease  can  be  communicated 
to  the  well  just  as  long  as  any  desquamating 
skin  remains.  Disinfection  before  desquama- 
tion  ceases  is  practically  a  waste  of  time.  Cats 
and  dogs  are  believed  to  carry  the  germs  in  Domestic 
their  coats  and  should  be  kept  out  of  the  sick  Animals- 
room.  Use  carbolized  oil  as  an  inunction  in 
all  of  these  diseases  to  prevent  or  lessen  the 
danger  from  floating  particles  of  skin.  Gowns 
and  bed  linen,  which  are  full  of  these  particles, 
should  be  removed  carefully  and  placed  at 
once  in  a  disinfectant  solution.  Do  not  shake 
them  about  the  room.  Wipe  all  furniture  and 
floors  with  a  cloth  wrung  out  of  a  disinfectant. 
Destroy  all  toys,  books,  etc.,  used  by  a  scarlet 
fever  patient,  by  fire  preferably.  When  nurs- 
ing scarlet  fever  in  a  private  home,  if  at  all 
possible,  obtain  two  sunny  communicating 
rooms  in  the  top  story  of  the  dwelling.  Have 
everything  you  may  need  for  the  care  of  your 
patient  and  yourself  in  the  room  adjoining  the 
sick  room,  in  order  to  avoid  the  danger  of 
carrying  infection  ta  other  parts  of  the  home. 
If  others  must  frequent  the  corridor  outside 
the  rooms  you  have  chosen,  keep  a  sheet  wrung 
out  of  carbolic  acid  solution  ( 1-20)  spread  over 
the  outside  of  doors  that  communicate  with 
79 


BACTERIOLOGY  IN  A  NUTSHELL. 

that  hallway  or  corridor.  Place  over  any 
opening  that  may  be  at  the  bottom  of  the  doors 
a  towel  or  cloth  saturated  with  the  same  solu- 
tion. Keep  in  the  closet  of  the  adjoining  room 
a  change  of  attire  to  be  worn  on  the  street 
when  you  go  out  for  an  airing,  and  be  careful 
not  to  place  in  this  closet  anything  you  have 
worn  or  used  in  the  sick  room.  Keep  in  this 
room  disinfectants  for  your  own  and  the 
physician's  hands  and  for  disinfecting  articles 
used  in  the  sick  room.  The  physician  will 
also  probably  leave  with  you  his  gown,  which 
he  wears  to  protect  his  street  garb  when  he 
makes  his  daily  visits  to  the  sick  room.  This 
you  must  also  keep  in  the  adjoining  room 
where  the  physician  dons  it  before  seeing  his. 
patient.  If  your  meals  are  sent  up  to  you 
from  the  general  kitchen,  be  sure  to  disinfect 
the  dishes  and  everything  on  the  tray  before 
placing  it  in  the  corridor  to  be  carried  down 
stairs.  A  small  ice  chest  in  which  to  keep 
articles  of  food,  such  as  pasteurized  milk,  eggs, 
etc.,  is  a  great  convenience,  in  fact  almost  a 
necessity,  and  should  of  course  be  placed  in 
the  room  adjoining  the  sick  room.  After 
desquamation  ceases  your  patient  must  be 
treated  to  several  baths  containing  a  disinfect- 
ant before  mingling  with  other  members  of  the 
family.  Nothing  worn  in  the  sick  room  may 
be  placed  on  your  patient  after  his  bath.  Use 
80 


COMMON    COMMUNICABLE    DISEASES. 

the  same  routine  in  all  diseases  in  which  there 
is  desquamation.  Be  very  thorough  in  per- 
sonal disinfection  before  going  to  another  case. 
MUMPS.  In  mumps  it  is  deemed  wise  to  dis- 
infect discharges  from  the  throat  and  nose.  Sources  of 
A  1  i  1  •  1  *.  t,  t  .LI  Communication 

Although  it  has  not  yet  been  proven  how  the  Unknown. 

disease  is  contracted,  it  is  conceded  by  all  to  be 
a  communicable  disease. 

TETANUS,  commonly  called  "lockjaw,"  is 
caused  from  the  invasion  of  wounds  by  a  germ  Bacillus 
known  as  bacillus  tetani,  usually  found  in  the 
soil  near  the  surface.  The  poisonous  matter  is 
thrown  off  through  the  pus  discharged  from  the 
wounds.  We  frequently  meet  with  cases  of 
tetanus  caused  by  the  patients  having  stepped 
on  a  nail  protruding  from  a  board  lying  in 
their  pathway.  The  nail  has  penetrated  the 
shoe,  entered  the  foot  and  carried  with  it 
particles  of  soil  containing  the  germs.  The 
bacillus  tetani  is  said  to  possess  the  power  to 
do  its  deadly  work  in  as  short  a  period  as 
twenty-four  hours,  and  but  rarely  to  cause 
mischief  later  than  the  tenth  day  after  the 
accident. 

In  the  past  few  years  a  number  of  cases  of 
tetanus  have  occurred  after  Fourth  of  July  cele-  Fourth  of 
brations,  arising  in  wounds  caused  by  toy  pis-  pis?ols.y 
tols.      Blank  cartridges  of  these  toys  are  said  to 
contain  the  germs,  although  authorities  are  of 
the  opinion  that  the  germs  are  probably  upon 
81 


Symptoms. 


Arching  of 
the  Back. 


Effect  of 
Medicines. 


BACTERIOLOGY  IN  A  NUTSHELL. 

the  soiled  hands  of  the  child  before  the  accident 
and  that  they  cause  trouble  in  the  wound  after- 
ward just  as  they  do  in  other  gunshot  accidents 
in  which  tetanus  arises.  A  law  was  passed  in 
1903  in  many  of  the  large  cities  of  the  United 
States  prohibiting  the  sale  of  these  pistols. 

The  throat  and  jaws  seem  to  be  the  parts 
most  affected  when  the  symptoms  first  appear. 
A  feeling  of  stiffness  and  sometimes  of  pain  in 
these  parts  is  complained  of.  Rapidly  the 
stiffening  of  the  jaws  increases.  Severe 
muscular  spasms  develop,  at  first  in  the  muscles 
of  the  jaw,  but  soon  to  spread  over  the  entire 
muscular  system.  The  spasms  increase  in 
rapidity  and  severity  until  they  are  kept  up 
almost  continuously.  •  (The  spasms  seen  in 
tetanus  are  somewhat  similar  to  the  spasms 
from  strychnia  poisoning.)  Eventually  the 
jaws  become  tightly  clenched,  the  back  is  bowed 
and  the  patient  is  frequently  found  to  rest  only 
on  the  back  of  his  head  and  his  heels,  the  rest 
of  the  body  arching  upward  from  the  bed. 
Death  commonly  occurs  from  exhaustion. 
The  majority  of  cases  prove  fatal. 

Medicines  seem  to  have  no  effect  in  arresting 
the  progress  of  tetanus.  Chloroform  ami 
opiates  are  used  by  many  physicians  for  the 
temporary  relief  they  give  from  the  violence  of 
the  spasms.  In  recent  years  the  antitoxin 
treatment  has  saved  some  lives.  In  order  to 
82 


COMMON    COMMUNICABLE    DISEASES. 

be  of  any  marked  value  it  must  be  administered 
early  in  the  case. 

The  nurse  is  instructed  to  keep  the  patient's 
room  darkened  and  to  guard  him  from  all  dis- 
turbances.  Noises  are  said  to  aggravate  the 
spasms,  and  she  is  cautioned  to  keep  him  quiet. 
He  should  be  watched  very  closely  and  must 
not  be  left  alone  a  minute.  Strenuous  efforts 
to  give  him  nourishment  must  be  made.  As 
the  jaws  are  tightly  clenched,  recourse  is  had  to 
nutrient  enemata.  "Nose  feeding"  is  not 
recommended  by  the  best  authorities,  as  it  is 
believed  to  aggravate  the  spasms.  Opiates  are 
sometimes  given  by  rectal  injection  also. 

The  best  authorities  now  recommend 
opening  up  accidental  wounds  as  quickly  as  Preventive 
possible  after  they  occur.  A  thorough  irriga-  easures- 
tion  of  the  wound  with  an  antiseptic  solution 
then  follows,  such  irrigation  to  be  kept  up  at 
frequent  intervals  until  all  danger  of  the  in- 
vasion of  the  bacillus  tetani  is  over.  Between 
the  irrigations,  the  wound  is  protected  by  an 
aseptic  dressing  held  in  place  by  a  bandage. 
Some  advocate  leaving  the  wound  open  to 
the  air  after  irrigation,  claiming  that  the 
bacillus  tetani  will  not  live  in  the  presence 
of  air. 

ERYSIPELAS,   at  one  time  regarded  as  an 
acute  inflammation  of  the  skin,  is  now  attrib-  cause  of 
uted  to  the  invasion  of  the  system  by  the  strep-  Erysipelas. 
83 


BACTERIOLOGY  IN  A  NUTSHELL. 

tococcus  pyogenes*  which  gains  an  entrance 
through  wounds,  and  sometimes  through 
scratches  or  punctures  of  the  skin  so  tiny  as  to 
be  almost  imperceptible  to  the  naked  eye.  The 
disease  is  spread  by  means  of  small  particles 
of  desquamating  skin  from  the  affected  part 
floating  in  the  air  and  by  pus  from  the  wound 
Channels  in  some  cases.  It  is  carried  from  one  person 

to  another  by  actual  contact,  clothing,  or  other 
infected  articles,  such  as  dishes,  bedding, 
towels,  dressings,  and  anything  used  by 
patients.  It  may  also  be  communicated  by  the 
hands  of  the  physician  or  nurse  or  by  instru- 
ments used  in  treating  the  case.  All  such  out- 
lets and  inlets  of  this  most  mischievous  germ 
must  be  well  guarded  by  the  nurse.  Burn  all 
old  dressings  immediately  and  use  disinfect- 
ants rigidly  throughout  the  case  and  at  the 
close  of  the  case.  All  cases  must  be  isolated 
and  given  to  the  care  of  a  special  nurse.  The 
"eternal  vigilance"  ordered  in  the  nursing  of 
scarlet  fever  and  other  desquamating  diseases 
must  be  rigidly  adhered  to  in  erysipelas. 

While  the  erysipelas  germ  is  liable  to  attack 
wounds,  the  disease  frequently  appears  where 
there  is  no  perceptible  wound.  A  rose-red 
blush  of  the  skin  is  seen.  The  edges  of  the 

*  When  the  streptococcus  pyogenes  invades  the  skin 
we  have  erysipelas;  when  it  invades  the  blood,  we 
have  septicemia  or  "sepsis,"  and  other  inflammations  in 
which  suppuration  occurs. 

84 


COMMON    COMMUNICABLE    DISEASES. 

affected  area  are  clearly  distinct  from  the 
healthy  surroundings.  There  is  usually  a 
swollen  condition  and  the  sick  one  complains 
of  a  tightness  and  stiffness  in  the  diseased 
region.  Erysipelas  spreads  rapidly  when  it  at- 
tacks loose  tissues,  such  as  those  of  the  face, 
and  preventive  applications  have  to  be  made 
early  in  the  case.  It  is  a  very  severe  disease  in 
some  instances,  particularly  so  in  persons  ad-  Subjects, 
dieted  to  the  habit  of  using  alcoholics  to  excess. 

Various  parts  of  the  system  are  affected  as 
shown  by  elevation  of  temperature,  nausea,  and 
frequently  vomiting,  headache,  rapid  pulse,  and 
after  the  disease  is  well  advanced  in  bad  cases 
there  may  be  delirium  and  exhaustion.  The 
disease  sometimes  proves  fatal. 

TUBERCULOSIS.  All  forms  of  this  disease, 
which  attacks  various  parts  of  the  human  struc- 
ture, are  caused  by  the  bacillus  tuberculosis. 
Tuberculosis  of  the  lungs  is  called  phthisis  or 
consumption.  When  the  germs  attack  the 
lymphatic  glands  the  disease  is  spoken  of  as 
scrofula.  Tuberculosis  of  the  skin  is  termed 
lupus.  The  nurse  meets  with  tubercular  joint 
disease,  tubercular  disease  of  the  kidneys, 
tubercular  meningitis,  tubercular  peritonitis 
and  so  forth. 

The  germ  which  is  responsible  for  the  de-  , 

Methods  of 

velopment  of  tuberculosis  generally  gains  ad-  Entrance, 
mission  to  the  system  through  breathing  in  air 
85 


Predisposing 
Causes. 


Early 
Precautions. 


BACTERIOLOGY  IN  A  NUTSHELL. 

in  which  they  are  circulating,  but  it  may  be 
taken  in  through  other  sources ;  for  instance,  by 
drinking  milk  containing  the  germs.  Jersey 
cows  are  said  to  be  subject  to  tuberculosis  and 
their  milk  apt  to  contain  the  germs.  Wounds 
also  admit  the  germs. 

Persons  predisposed  to  tuberculosis  are  those 
whose  chests  are  not  well  developed,  whose  cir- 
culation is  poor  and  whose  vitality  is  low,  par- 
ticularly if  their  surroundings  and  occupations 
are  unhealthy.  Those  who  have  to  work  in 
dusty,  overheated,  badly  ventilated  rooms,  for 
example.  Insufficient  or  poor  food  is  given  as 
another  cause  favoring  the  development  of  the 
disease.  When  one  of  these  causes,  or  several 
of  them,  weaken  the  structure,  power  of  re- 
sistance is  lessened,  and  when  the  germs  gain 
an  entrance  we  fall  an  easy  prey  to  the  ravages 
of  the  disease,  if  they  are  not  sought  after  and 
driven  out  at  an  early  stage. 

The  duties  of  the  nurse  when  caring  for  a 
tubercular  patient  are  to  thoroughly  disinfect 
all  sputa,  cleanse  and  disinfect  all  sputa  cups, 
and  to  destroy  by  fire  all  dressings  used  on 
tubercular  wounds.  Many  physicians  demand 
that  sputa  be  burned  also,  and  special  sputa 
cups  are  now  in  use  with  a  detachable  water- 
proof lining  made  of  a  sort  of  pasteboard. 
These  linings  are  put  up  in  packages  which 
come  with  each  sputa  cup.  They  are  easily 
86 


COMMON    COMMUNICABLE    DISEASES. 

slipped  in  and  out  and  are  changed  several 
times  a  day.  They  are  burned  immediately  on 
removal  from  the  cup.  Bed  and  personal 
clothing  (particularly  handkerchiefs)  must  be 
treated  to  a  bath  of  boiling  water  or  well 
soaked  in  a  good  disinfectant  solution  before 
placing  in  the  general  wash.  Boil  all  dishes 
used  for  feeding  purposes  in  a  2%  sal  soda 
solution  at  least  once  daily  for  ten  minutes. 
While  tubercular  patients  are  not  isolated  in 
the  same  sense  in  which  scarlet  fever  or 
diphtheria  patients  are,  they  should  occupy 
separate  bedrooms  and  the  use  by  others  of  a 
tubercular  patient's  dishes  should  be  FOR- 
BIDDEN. 

Keep  your  patient  out  of  doors  in  the  fresh 
air  and  sunshine  as  much  as  possible.  "Out  of  Fresh  Air 
doors  all  the  time,  and  sleep  and  eat  in  the  open 
air  in  a  proper  climate"  is  getting  more  and 
more  to  be  the  prescribed  treatment.  To 
which  is  added  as  indispensable,  plenty  of 
nourishing,  easily-digested  food,  especially  an 
abundance  of  milk  and  eggs,  perfect  cleanliness 
and  neatness  of  person  and  surroundings  and 
a  cheerful  atmosphere  at  all  times.  The  nurse 
who  pays  strict  attention  to  all  of  these  re- 
quisites is  a  valuable  and  valued  assistant  to 
the  physician  fighting  this  disease. 

MALARIA.     Malaria  is  now  classed  as  a  dis- 
ease of  bacterial  origin  and  is  believed  to  be  Anopheles!" 
87 


Plasmpdium 
Malariae. 


Length  of 
Days  and 
Multiplication. 


BACTERIOLOGY  IN  A  NUTSHELL. 

carried  from  the  sick  to  the  well  by  a  species 
of  mosquito — the  anopheles.  Those  who  live 
in  low,  damp  localities  or  near  "swampy" 
regions  are  more  apt  to  be  attacked.  Tn  such 
places  window  screens  and  doors  with  a  very 
close  mesh  should  be  used  to  prevent  the  in- 
vasion of  the  anopheles.  The  germ  to  which 
the  poison  of  malaria  is  said  to  be  due  is  called 
plasmodium  malariae.  These  germs  get  into 
the  red  corpuscles  of  the  blood,  live  upon  them, 
and  destroy  them.  We  are  taught  that  there 
are  three  varieties  of  the  malaria  germ,  as  there 
are  also  three  forms  of  the  disease,  one  of 
which  lives  in  the  human  structure  seventy-two 
hours,  and  the  other  two  forty-eight  and 
twenty-four  hours,  respectively.*  Their 
death,  sad  to  say,  does  not  mean  the  end  of 
the  mischief  they  accomplish,  as  when  they 
cease  to  exist  themselves  they  divide  up  into  a 
number  of  tiny  particles  or  segments  each  of 
which  means  a  new  life  or  germ.  These  new 
germs  attack  other  red  corpuscles  and  live  upon 
them  until  they,  too,  die,  but  in  dying  they 
form  new  parasites,  as  their  parent  germs  did 

*  The  names  given  to  the  three  forms  or  species  of 
the  plasmodium  are,  (i)  plasmodium  praecox,  found  in 
aestivo-autumnal  malaria,  living  twenty-four  hours; 
(2)  the  plasmodium  vivax  of  the  tertian  form  of 
malaria,  the  life  of  which  is  forty-eight  hours;  (3)  the 
plasmodium  malariae,  found  in  the  quartan  form  of 
malaria,  which  has  a  seventy- two-hour  life. 


COMMON    COMMUNICABLE    DISEASES. 

before  them.     Each   fresh   set  of  germs  de- 
stroys a  large  number  of  the  red  corpuscles. 
Koch,  and  other  scientists,  who  teach  that 

the  germ  is  carried  by  mosquitoes,  believe  they  Mode  of 
,,,.,.        •      •    r         i          1     •  Communica- 

slake  their  thirst  in  infected  pools  in  swamps  tion> 

and  then  alighting  on  healthy  bodies  they  com- 
municate to  them  the  disease — producers  by 
inoculation.  They  also  teach  that  these  mos- 
quitoes carry  the  poison  in  the  same  way  from 
the  sick  to  the  well.  Prevention  is  only  pos- 
sible by  destroying  the  mosquitoes. 

UNCINARIASIS,  another  disease  caused  by  an 
animal  parasite,  the  uncinaria  duodenalis,  is 
quite  common  in  the  United  States  as  well  as 
in  other  parts  of  the  world,  and  is  often 
diagnosed  as  malaria,  some  of  the  symptoms 
being  similar.  The  seat  of  invasion  in  un- 
cinariasis  is  the  duodenum,  the  jejunum  and 
less  frequently  the  colon.  Other  names  given 
to  uncinariasis  are  hook-worm  disease,  anchylo- 
ostomiasis,  Egyptian  chlorosis,  etc.  Hook- 
worm disease  is  its  commonest  title.  This 
name  has  probably  arisen  because  of  the 
peculiar  bending  backward  upon  itself  of  the 
anterior  portion  of  the  parasite,  giving  to  it  a 
hook-like  appearance  when  observed  under  the 
microscope.  These  germs  are  blood  devourers 
and  by  means  of  peculiar  tooth-like  and  suction 
appendages  they  cling  to  the  mucous  mem- 
brane that  lines  the  intestine.  In  this  position 
89 


BACTERIOLOGY  IN  A  NUTSHELL. 

they  suck  the  blood  of  their  victims.  A  pro- 
nounced anaemia,  of  course,  follows.  This  is 
one  symptom  found  also  in  malaria.  The 
plasmodium  malariae  causes  anaemia  by  its 
power  to  destroy  the  red  corpuscles  of  the 
blood.  The  germs  of  the  uncinaria  duodenalis 
enter  the  body  in  drinking  water  or  from  hands 
that  have  become  soiled  with  dust  containing 
the  parasites.  They  are  also  said  to  be  able 
to  gain  an  entrance  through  the  skin  from 
whence  they  are  carried  by  the  blood  into  the 
right  side  of  the  heart  and  to  the  lungs. 
From  the  pulmonary  blood-vessels  they  are 
thrown  into  the  air  spaces  and  carried  upward 
to  the  bronchial  tubes,  larynx  and  into  the 
oesophageal  tract ;  then  they  are  swallowed  and 
finally  pass  into  the  stomach  and  gain  their 
camping  ground,  the  intestine.  The  disease 
this  micro-organism  produces  is  frequently 
fatal.  Diagnosis  is  made  by  examining  a  small 
particle  of  feces  under  the  microscope. 

CEREBRO-SPINAL  MENINGITIS  is  caused  by 

The  Germ  a  ^ie    diplococcus    intracellularis    meningitidis. 

Diplococcus.  It  is  not  communicated  from  the  sick  to  the 

well  in  the  same  manner  in  which  most  com- 
municable diseases  are,  and  the  germs  are  not 
found  in  the  excretions  unless  there  are  lesions 
formed  either  of  the  brain  or  spinal  cord.  The 
exact  method  by  which  the  germs  enter  and 
leave  the  structure  has  not  been  fully  decided 
90 


COMMON    COMMUNICABLE    DISEASES. 

upon  by  scientists,  but  nurses  are  instructed 
that  it  is  safest  to  disinfect  all  discharges  from 
the  body,  all  personal  clothing  and  bed  linen; 
also  to  fumigate  the  room  at  the  close  of  the 
case. 

The  seat  of  invasion  in  cerebro-spinal  men- 
ingitis is  in  the  membranes  which  cover  and  Seat  of 

Attack. 
enclose  the  brain  and  spinal  cord.     The  germs 

set  up  an  inflammation  of  these  membranes, 
which  are  known  as  the  meninges,  but  the 
poison  is  also  distributed  to  other  parts  of  the 
body.  Inflammation  of  the  meninges  is  a 
characteristic  symptom  by  which  the  disease  is 
made  manifest.  Sometimes  only  a  small  por- 
tion is  affected,  at  other  times  the  greater  part 
of  the  cerebral  surfaces  are  involved.  This  is 
one  of  the  very  few  diseases  in  which  the  nurse 
is  told  that  lack  of  strict  personal  cleanliness, 
so  far  as  the  patient  is  concerned,  must  some- 
times be  permitted  because  of  the  necessity  for 
absolute  rest  and  freedom  from  all  movement. 
About  one-half  of  the  number  of  cases  of 
cerebro-spinal  meningitis  end  in  death,  and 
about  three-fourths  of  its  victims  are  children 
under  ten  years  of  age.  There  have  been 
epidemics  of  the  disease  in  the  United  States. 
One  of  the  most  appalling  occurred  in  a  small 
town  in  Pennsylvania  (population  6,000)  in 
1864,  when  it  is  said  that  some  four  hundred 
children  lost  their  lives.  The  very  best  med- 
gi 


The  Germ  of 
the  Disease. 


Why  Named 
for  Pneumonia. 


BACTERIOLOGY  IN  A  NUTSHELL. 

ical  attention  and  most  careful  nursing  are 
necessary  to  bring  about  recovery. 

PNEUMONIA.  Pneumonia  is  one  of  the 
most  serious  of  all  diseases  due  to  the  invasion 
of  the  human  structure  by  bacteria.  The 
special  germ  to  which  this  disease  owes  its 
origin  is  the  diplococcus  pneumonia,  or 
"Fraenkel's  diplococcus  lanceolatus,"  which  is 
also  said  to  produce  meningitis,  pleurisy  and 
ulcerative  endocarditis.  The  disease  produced 
in  all  cases  is  an  inflammation,  the  manifesta- 
tion of  which  is  modified  by  the  portion  of  the 
body  invaded.  Pneumonia  is  an  inflammation 
of  the  lungs,  sometimes  of  one  or  more  of  the 
lobes  of  one  lung,  sometimes  of  the  lobes  of 
both  lungs,  or  it  may  be  an  inflammation  of  all 
of  both  lungs.  Endocarditis  is  an  inflammation 
of  the  endocardium  or  membrane  lining  the 
heart.  Meningitis  is  an  inflammation  of  the 
meninges  or  membranes  which  enclose  and 
cover  the  brain  and  spinal  cord.  These  various 
organs  have  various  functions ;  this  function  is 
interfered  with  when  the  organ  becomes  in- 
flamed and  the  symptoms  are  different,  while 
the  cause  may  be  the  same.  The  germ  was 
discovered  first  in  the  lungs  in  pneumonia  and 
took  its  name  from  that  disease.  As  was  men- 
tioned in  Chapter  I,  broncho-pneumonia  is 
often  caused  by  other  germs,  but  authorities  are 
of  the  opinion  that  in  genuine,  acute,  lobar 
92 


COMMON    COMMUNICABLE    DISEASES. 

pneumonia     the     diplococcus     pneumonia     is 

always  present.     The  germ  is  a  very  common 

one.     It  is  found  in  the  dust  and  sweepings  of 

rooms  and  is  frequently  present  in  the  mouths 

of  the  healthy.     Exposure  to  severe  weather  or 

dampness  which  has  produced  a  heavy  cold 

acts  as  a  predisposing  cause.     The  system  is  Predisposing 

invaded,  resistive  power  weakened,  and  an  at-  Influences. 

tack  of  pneumonia  follows.     The  germs  enter 

the  lungs  through  the  respiratory  tract  often 

causing  disastrous  changes  in  these  organs. 

The   poison    is    eliminated    from   the    system 

through  the  secretions  from  the  seat  of  the  Entrance  and 

disease,  usually  the  sputum,  which  should  be 

disinfected  or  burned  as  in  tuberculosis. 

Pneumonia  has  been  called  the  "Captain  of 
the  Men  of  Death,"  because  it  carries  off  annu-  Importance  of 
ally  more  victims  than  any  other  disease.  In 
few  other  forms  of  illness  is  such  constant  care 
and  watchfulness  on  the  part  of  the  nurse  de- 
manded as  in  pneumonia.  The  disease  usually 
ends  by  crisis,  when  collapse  or  great  prostra- 
tion of  all  the  vital  forces  may  occur.  Or  the 

..      ,  -  Immediate 

patient  may  die  during  the  course  of  a  severe  Causes  of 

form  of  the  disease  from  suffocation  or  heart  Death- 
failure.  Such  patients  must  not  be  left  alone 
under  any  consideration.  Heart  failure,  is 
perhaps,  a  point  especially  to  be  impressed  upon 
the  nurse,  as  any  sudden  exertion  or  excitement 
on  the  part  of  the  patient  may  bring  about  the 
93 


BACTERIOLOGY  IN  A  NUTSHELL. 


Obermeier's 
Germ. 


Method  of 

Communication 

Uncertain. 


Impure 
Water  and 
Mosquitoes. 


dread  calamity.  One  attack  of  pneumonia  in- 
stead of  affording  immunity,  seems  to  predis- 
pose to  other  attacks. 

RELAPSING  FEVER.  The  micro-organism 
which  causes  relapsing  fever,  discovered  by 
Obermeier  in  1873,  'ls  termed  Spirocheta 
Obermeieri.  Scientists  are  of  the  opinion  that 
the  disease  is  carried  from  the  sick  to  the  well 
by  the  bite  of  insects,  although  the  actual 
method  has  not  been  fully  determined.  An 
epidemic  of  relapsing  fever  occurred  in  New 
York  and  Philadelphia  in  1869.  It  i?  not  a 
common  disease  in  recent  years,  and  epidemics 
unheard  of,  owing  to  improved  sanitary  con- 
ditions. 

FILARIASIS  is  a  disease  due  to  the  filiaria  san- 
guinis  hominis,  a  small  worm-like  parasite.  It 
is  admitted  to  the  body,  usually,  through  the 
alimentary  canal  in  impure  drinking  water. 
Mosquitoes  are  believed  by  some  authorities  to 
cause  a  spread  of  the  disease  by  the  inoculation 
of  their  victims  with  the  blood  of  diseased  per- 
sons. The  seat  of  the  disease  is  the  deeper 
lymphatics.  Prominent  symptoms  are  chyle 
in  the  urine,  oedema  of  the  skin  (swelling  due 
to  effusion  into  connective  tissue),  and  hyper- 
trophy (morbid  enlargement)  of  the  cellular 
tissues,  known  as  "elephantiasis." 

Prevention  consists  in  removing  the  sources 

94 


COMMON  COMMUNICABLE  DISEASES. 

whereby  drinking  water  is  contaminated  and  in  pre       . 
destroying  the  mosquito. 

YELLOW  FEVER.  The  seat  of  invasion  in 
yellow  fever  is  the  blood.  While  yellow  fever 
is  not  a  disease  commonly  met  with  by  the  nurse 
in  this  part  of  the  country,  we  will  speak  of  it 
briefly  in  this  connection.  It  is  a  disease  which 
is  very  rapidly  spread  by  means  of  a  species  of 
mosquito,  the  stegomia  fasciata.  Dr.  Carlos 
Finlay,  of  Cuba,  in  the  year  1881,  first  pro- 
claimed positively  that  this  species  of  mosquito 
carries  the  yellow  fever  germ,  which  as  yet 
remains  undiscovered.  A  number  of  Ameri- 
can physicians  had  been  suspicious  of  the 
mosquito  years  prior  to  this  time,  having  ob- 
served their  prevalence  during  yellow  fever 
epidemics.  Dr.  Rush,  in  1793;  Dr.  Weight- 
man,  in  1839;  Drs.  Wood  and  Barton,  in  1853, 
all  had  given  voice  to  this  opinion.  These 
insects  transmit  the  germs  by  direct  inocula-  Qause 
tion  of  blood  from  the  sick  to  the  well.  The 
disease  is  not  air  borne,  nor  is  it  carried  in 
clothing,  books  or  other  such  articles.  The 
mosquitoes  must  be  destroyed  in  order  to  pre- 
vent the  spread  of  the  disease. 

In  the  Southern  States  and  in  Mexico,  where 
epidemics  of  yellow  fever  occur  every  year, 
physicians  surround  the  beds  of  patients  sus- 
pected to  be  developing  the  disease  with  a  net- 
ting to  prevent  the  onslaughts  of  the  mos- 
95 


Preventive 
Measures. 


The  Bacillus 
Pestis. 


BACTERIOLOGY  IN  A  NUTSHELL. 

quitoes.  Dr.  Walter  Wyman,  surgeon  of  the 
U.  S.  Marine  Hospital,  in  speaking  of  the 
disease  in  Texas  and  in  Mexico,  says  that  it  is 
necessary  to  screen  the  beds  of  "suspects"  be- 
cause it  is  not  possible  to  tell  until  the  fifth 
day  whether  or  not  the  disease  is  the  "dread 
yellow  variety"  which  is  communicable  only 
"during  the  first  three  days."  Strenuous 
efforts  are  being  made  by  the  health  officers  in 
all  parts  of  Texas  and  Mexico  to  exterminate 
the  pestilence-breeding  and  disease-carrying 
mosquitoes.  Water  barrels,  which  are  much 
used  in  these  places  and  which  form  favorite 
haunts  for  the  mosquitoes,  are  screened  also. 
All  pools  and  swamps  are  treated  with  oil  and 
in  some  places  drained  and  filled  in. 

BUBONIC  PLAGUE  is  caused  by  the  bacillus 
pestis.  The  seat  of  invasion  of  this  germ  is 
the  skin  and  subcutaneous  tissues,  the  lym- 
phatics, the  lungs  and  the  intestinal  tract. 
Authorities  teach  us  that  the  pneumonic  form 
is  the  most  dangerous  and  the  most  readily 
communicable.  All  the  discharges,  clothing, 
etc.,  must  be  treated  to  a  hot  carbolic  acid  solu- 
tion bath,  strength  1-20.  Floors  and  wood- 
work must  be  washed  daily  with  a  solution  of 
bichloride  of  mercury  1-1,000.  Patients  must 
be  rigidly  isolated  and  dead  bodies  cremated. 
While  this  disease  is  one  commonly  confined  to 
Eastern  countries,  it  may  be  carried  into  our 
96 


COMMON  COMMUNICABLE  DISEASES. 

ports  on  ships  infested  with  rats,  mice  and 
other  vermin.  Adhere  rigidly  to  personal  dis- 
infection at  the  close  of  the  case,  and  all 
through  the  case.  This  germ  has  the  power 
to  enter  the  body  through  wounds,  the  alimen- 
tary canal,  or  the  respiratory  tract.  The  in- 
fection is  thrown  off  in  the  pus  from  wounds, 
in  sputum  and  in  discharges  from  the  body. 
When  a  wound  is  invaded  by  the  germs,  a 
severe  local  inflammation  results  and  quickly 
spreads  to  the  lymphatic  glands.  Flies  and 
other  insects  are  said  to  transmit  the  disease. 

SMALLPOX.  The  micro-organism  which 
causes  smallpox  was  reported  as  discovered  by  Discovery  of 
Dr.  Wm.  T.  Councilman,  of  Harvard  College, 
Boston,  Mass.,  in  the  early  spring  of  1904. 
He  made  known  his  discovery  during  the 
course  of  a  lecture  given  in  that  city  on  "The 
Aetiology  of  Smallpox."  He  described  the 
germ  of  smallpox  as  a  "protozoon,"  represent- 
ing the  very  lowest  order  of  animal  life  and 
therefore  quite  different  from  the  vegetable 
micro-organisms  common  to  the  majority  of 
communicable  diseases.  Dr.  Councilman  is 
said  to  have  proven  that  his  germ  will  pro- 
duce smallpox  by  his  experiments  on  rabbits 
and  monkeys,  but  as  it  is  not  produced  by  cul- 
tures Koch's  circuit  is  not  traced.  The  small- 
pox  infection  is  general.  It  invades  the  skin, 


BACTERIOLOGY  IN  A  NUTSHELL. 


An  Air-borne 
Disease. 


A  Matter  of 
Precaution. 


the  conjunctiva,  the  mouth,  the  oesophageal 
tract,  the  rectum,  and  the  blood. 

Smallpox  is  one  of  the  air-borne  diseases  and 
enters  the  system  through  the  respiratory  tract 
and  may  also  be  introduced  through  the  skin. 
The  disease  is  so  readily  communicable  that  all 
discharges  must  at  once  be  disinfected  or 
burned.  The  chief  factors  in  the  spread  of  the 
disease  are  the  secretions  from  the  nose  and 
throat  and  the  desquamating  skin,  all  of  which 
contain  the  poison.  Flies  which  alight  on  the 
patients  spread  the  disease.  Patients  must  be 
protected  by  screens  about  their  beds.  Great 
care  should  be  observed  to  prevent  particles  of 
peeling  skin  from  being  carried  by  the  air  as 
floating  dust.  In  giving  the  baths  the  water 
should  contain  a  disinfectant.  Antiseptic 
washes  are  used  and  also  inunctions  of  anti- 
septic ointments  or  oils  to  lessen  the  danger 
from  desquamation.  Formaldehyde  vapor  is 
recommended  for  fumigation  after  disinfection 
at  the  close  of  the  case. 

A  lecturer*  on  "Specific  Fevers"  when  speak- 
ing in  the  writer's  presence  on  the  subject  of 
smallpox  a  few  years  ago,  advised  a  class  of 
pupil  nurses  as  a  matter  of  precaution  to  "burn 
everything  but  the  patient  at  the  close  of  the 
case." 


*  Dr.  Robert  Saunders  Henry,  lecturer  on  Specific 
Fevers,  Thomas  Hospital,  Charleston,  West  Virginia, 
'98  to  '02. 


SUMMARY    AND    REVIEW. 

Preventive  treatment  in  smallpox  epidemics 
consists  in  the  rigid  carrying  out  of  vaccina-  Danger.1"8 
tion.     It  is  not  considered  that  a  nurse  who 
has  been  recently  vaccinated  incurs  the  slightest 
risk  in  nursing  small  pox. 

SUMMARY  OF   CHAPTER  V. 

The  terms  contagious  and  infectious  as 
formerly  used  have  given  place  to  the  more 
accurate  term  "communicable." 

The  specific  invading  micro-organism  of 
some  of  the  communicable  diseases. 

Means  of  transmission — methods  of  en- 
trance. 

Seat  of  invasion. 

Effects — constitutional  or  local. 

Multiplication  or  extermination  of  germs. 

Cleanliness  and  fresh  air  as  preventives  of 
diseases  termed  communicable. 

The  points  demanding  most  careful  atten- 
tion on  the  part  of  the  nurse  in  all  communic- 
able diseases.  Disinfection,  etc. 

QUESTIONS  FOR  REVIEW  CHAPTER  V. 

I. — Give  the  nurse's  duties,  especially  as  ap- 
plied to  the  severe  forms  of  infectious  diseases. 

II. — Give  methods  of  entrance  and  means  of 
communication  in  the  diseases  designated; 
typhoid  fever,  diphtheria,  scarlet  fever,  tetanus, 
tuberculosis,  smallpox. 

99 


BACTERIOLOGY  IN   A  NUTSHELL. 

III. — What  location  is  named  as  the  seat  of 
invasion  in  typhoid  fever?  Describe  the  pro- 
gress of  the  disease  resulting  in  hemorrhage 
and  perforation. 

IV. — In  which  of  the  communicable  diseases 
do  you  consider  most  rigid  disinfectant  and 
antiseptic  precautions  necessary? 

V. — Name  some  communicable  diseases  be- 
lieved to  be  due  to  impure  water. 

VI. — Describe  symptoms  of  tetanus.  State 
the  usual  cause  of  the  disease.  How  long  after 
injury  may  danger  of  the  attack  exist?  What 
treatment  is  recommended  as  preventive? 

VII. — What  conditions  are  conducive  to  the 
development  of  tuberculosis?  Give  method 
adopted  as  preventive  of  its  spread.  Name 
treatment  most  in  favor  and  state  the  nurse's 
duties. 

VIII. — How  is  the  mosquito  responsible  for 
the  spread  of  malaria?  What  effect  has  the 
disease  upon  the  blood  of  its  victims  ?  Are  the 
parasites  long  lived  ?  In  what  manner  do  they 
multiply  ? 

IX. — Which  are  most  susceptible  to  menin- 
gitis, old  or  young  people?  Why  are  the 
methods  of  cleanliness  so  rigidly  carried  out  in 
other  infectious  diseases  not  recognized  in 
meningitis  ? 

X. — What  conditions  favor  the  develop- 
ment of  pneumonia  ?  Show  why  constant  vig- 
100 


SUMMARY    AND    REVIEW. 

i  lance  in  caring  for  a  pneumonia  patient  is  so 
necessary. 

XL — To  what  means  of  communication  is 
yellow  fever  confined  ?  What  preventive  meas- 
ures are  used? 

XII. — How  does  the  germ  of  smallpox  dis- 
covered by  Councilman  differ  from  those  of 
most  other  communicable  diseases?  What 
essential  part  of  Koch's  circuit  is  not  carried 
out? 

XIII. — Why  should  a  strenuous  use  of  dis- 
infectants be  maintained  in  nursing  smallpox? 
Name  the  principal  preventive  treatment. 

XIV. — Does  the  nurse  incur  greater  risk  in 
nursing  smallpox  than  in  nursing  other  severe 
forms  of  communicable  diseases  ? 


ior 


BACTERIA  IN  SURGERY. 
CHAPTER  VI. 

SEPSIS,  ASEPSIS  AND  ANTISEPSIS. 

In  surgical  practice  the  bacteria  met  with 
most  frequently  are  the  following : 

THE  STAPHYLOCOCCUS  PYOGENES  AUREUS, 
Germs  tjie  streptococcus  pyogenes,  the  bacilli  coii 

Encountered.  communis,  the  bacillus  tuberculosis  and  the 
bacillus  tetani. 

THE  STAPHYLOCOCCUS  *  PYOGENES  AUREUS. 
Water,  dust  and  air  are  all  means  by  which  this 
micro-organism  is  distributed.  It  is  found, 
also,  in  the  mouth,  under  the  finger-nails,  and 
in  superficial  layers  of  skin.  This  is  the  germ 
most  frequently  found  to  be  concerned  in 
severe  forms  of  inflammation  confined  to  small 
areas  in  which  pus  *is  found,  described  as 
"acute,  suppurative  circumscribed  inflamma- 
tion." Whie  the  staphylococcus  pyogenes 
aureus  does  not  form  spores,  it  is  very  difficult 
to  destroy,  resisting  to  a  remarkable  degree  all 
means  used  for  its  extermination. 

THE  STAPHYLOCOCCUS  PYOGENES  *ALBUS 
AND  *CITREUS.  These  germs  are  found  in  the 

*  Pyogenes    signifies    pus-forming ;    Aureus,    golden- 
yellow. 

*  Albus  means  white. 

*  Citreus,   citron-yellow.      These  colors  are  assumed 
when  seen  in  growing  cultures. 

1 02 


SEPSIS ASEPSIS ANTISEPSIS. 

pus  from  acute  abscesses,  but  are  less  virulent 
than  the  staphylococcus  pyogenes  aureus. 

STREPTOCOCCUS  PYOGENES.  One  of  the 
most  frequent  causes  of  peritonitis  after  sur- 
gical operations  (post  operative  peritonitis)  is 
said  to  be  the  germ  streptococcus  pyogenes.  It 
is  found  also  in  puerperal  endometritis  ( inflam- 
mation of  the  mucous  membrane  lining  the 
uterus  after  a  child  is  born)  ;  in  ulcerative  en- 
docarditis (inflammation  of  the  membrane 
lining  the  heart  accompanied  by  ulceration), 
and  is  also  believed  to  be  the  cause  of  general 
septicaemia  (general  poisoning  of  the  system 
due  to  bacteria  in  the  blood). 

DIPLOCOCCUS  PNEUMONIA.  This  micro- 
organism, or  germ,  is  found  in  empyema 
(formation  of  pus  in  a  cavity),  and  in  acute 
abscesses. 

BACILLUS  TETANI.  Surgeons  always  fear 
the  bacillus  of  tetanus  in  accidental  wounds, 
particularly  those  which  have  been  exposed  to 
danger  of  infection  from  the  dust  of  streets, 
stables,  or  cellars. 

SEPSIS,  ASEPSIS  AND  ANTISEPSIS.     Sepsis  is 
the  result  of  the  gathering  of  bacteria  into  the  The  Cause 
blood.     Bacteria,  as  we. have  already  said  in  a  °     epsis* 
previous    chapter,     is    the    name    given    by 
scientists  to  the  large  field  or  group  of  vege- 
table   micro-organisms    we    commonly    hear 
spoken  of  as  "germs"  or  "microbes." 
103 


BACTERIOLOGY  itf  A  NUtSHELL. 

We  have  also  said  that  there  are  special 
bacteria  for  special  diseases,  as  for  example  the 
"bacillus  typhosus"  in  typhoid  fever.  In  tu- 
berculosis the  "bacillus  tuberculosis,"  etc.  The 
shape  of  the  bacteria  in  many  instances  giving 
to  it  its  name,  viz. :  bacillus,  "rod-shaped  or 
pencil-like,"  spirilla,  "twisted  or  curved,"  cocci 
or  micro-cocci,  "sphere-shaped,"  or  like  a  ball 
or  marble,  with  modifications  or  subdivisions  of 
these  shapes  as  for  experimental  purposes  they 
are  cultivated  in  broth  or  other  liquid,  and  their 
varied  methods  of  forming  into  groups  is  seen 
under  the  microscope.  These  varied  groups 
are  spoken  of  as  "clusters,"  "chains,"  "twos,"' 
"fours,"  "eights,"  and  so  forth.  Sometimes 
the  disease  in  which  the  germ  is  first  found 
gives  to  it  its  name.  The  bacteria  found  in 
sepsis  when  seen  under  cultivation  are  grouped 
in  "chains,"  and  the  name  given  to  them  is 
streptococcus  pyogenes. 

SEPSIS  means  poisonous  or  putrid.  Asepsis, 
free  from  poison  or  putrefaction.  Antisepsis, 
against  poison  or  putrefaction.  Sepsis  is  found 
in  general  surgery,  in  gynecological  surgery 
and  in  obstetrics.  But  it  ought  not  to  be 
found  in  any  one  of  them.  In  these  days  of 
aseptic  surgery  when  so  much  time  arid 
thought  and  expense  are  given  to  the  prepara- 
tion of  the  patient,  operating-room,  dressings, 
surgeon's  gowns,  caps,  instruments,  etc.,  so  as 
104 


SEPSIS ASEPSIS ANTISEPSIS. 

to  render  all  these,  and  surgeons,  assistants  and 
nurses  as  well,  absolutely  free  from  poison 
(aseptic)  by  the  use  of  antiseptics  no  one  Sepsis  Should 
should  suffer  from  so  terrible  a  condition,  a  Not  Occur- 
condition  dreaded  by  all  physicians  and  nurses. 
Following  the  preparation  of  dressings,  ban- 
dages, gauze,  sponges,  etc.,  the  utmost  possible 
vigilance  is  necessary  in  order  to  be  sure  that 
all  are  kept  aseptic  after  they  have  been  made 
aseptic.  Of  what  avail  is  the  special  process 
they  undergo  if  the  packages  containing  them 
are  opened  and  the  dressings  passed  to  the 
surgeon  by  a  nurse  or  assistant  who  has  not 
been  properly  prepared  by  the  free  use  of  soap, 
.hot  water,  scrub-brush  and  the  after  thorough 
use  of  antiseptics,  especially  in  "hand  cleans- 
ing." Of  what  use  is  it  to  use  an  aseptic  Blunders 

During 
brush,  antiseptic  solutions  and  so  forth  in  pre-  Operations. 

paring  the  area  to  be  operated  upon  if  the  nurse 
who  uses  the  solutions  has  been  opening  and 
closing  windows  and  doors,  or  touching  other 
things  not  aseptic,  and  then  comes  to  take  part 
in  the  work  mentioned  without  first  thoroughly 
scrubbing  and  sterilizing  her  hands?  It  is 
after  just  such  blunders  as  these  in  operating 
rooms,  or  in  private  houses,  that  trouble  with 
the  patient  often  arises.  There  is  great  rea- 
son to  wonder  why  trouble  does  not  arise  in 
every  case  carelessly  handled.  Frequently  the 
patient  comes  through  the  operation  well,  and 
105 


BACTERIOLOGY  IN  A  NUTSHELL. 

for  a  day  or  two  seems  to  be  doing  nicely, 
then  comes  a  chill,  a  sudden  rise  of  tempera- 
ture, an  increased  pulse  rate,  the  patient  is  rest- 
less and  uneasy,  and  has  a  worn,  anxious  ex- 
pression; other  symptoms  more  or  less  alarm- 
ing appear.  The  physician  is  hastily  sum- 
moned, and  with  a  grave  face,  which  he  vainly 
tries  to  brighten  in  the  patient's  presence,  he 
examines  the  chart,  then  mutters  beneath  his 
breath  "sepsis;"  always  a  dread  word  even  to 
physicians  and  nurses  grown  old  in  the  work. 
He  removes  the  bandages  and  dressings  to  find 
abscesses  formed  about  the  stitches  he  had  put 
in  with  such  care,  or,  worse  still,  pus  oozing 
from  between  the  stitches.  Then,  comes  a 
hand  to  hand  fight  to  overcome  the  effects  of 
the  poison  and  to  save  human  life,  which,  sad 
to  say,  cannot  always  be  accomplished,  no 
matter  how  closely  the  physician's  orders  are 
carried  out. 

In  place  of  a  surgical  case  we  may  have  a 
case  of  ^obstetrics,  perhaps  a  case  in  which  it 

*  In  some  of  the  best  Maternity  Hospitals  of  the 
present  day  all  personal  clothing,  as  well  as  bed  linen, 
used  for  both  mother  and  infant  during  the  first  week 
are  sterilized,  just  as  for  a  surgical  case.  This  applies 
especially  to  the  gowns,  abdominal  bandages,  perineal 
pads,  diapers,  etc.  These  are  put  up  in  packages,  sep- 
arate from  those  containing  gauze  for  the  cord,  silk, 
etc.  Each  package  contains  sufficient  clothing  for  one 
day.  After  sterilization  they  are  not  handled  until 
needed.  Infants  so  cared  for  are  said  to  be  less 
troubled  with  skin  eruptions,  and  there  are  no  infections 
of  the  cord.  Sterilization  of  articles  used  for  the 
mother  serves  as  a  further  protection  against  sepsis. 
106 


STERILIZATION    AND   DISINFECTION. 

has  been  necessary  to  use  instruments.  The 
nurse  in  preparing  them  for  the  physician's  use 
has  not  been  sufficiently  careful,  or  in  some 
other  way  something  containing  the  germs  of 
disease  has  been  carried  into  the  puerperal 
genital  tract.  Again  we  have  the  character- 
istic symptoms  observed  in  the  surgical  case,  sepsis  Cases 
and  again  the  dread  word  "sepsis/'  rings  in  our 
ears.  Glad  we  are  to  be  able  to  say  that  such 
cases  are  more  rarely  encountered  as  the  years 
go  by.  A  conscientious,  well-trained  nurse 
will  watch  every  corner,  and  will  let  no  source 
of  infection  escape  her  keen  eye.  She  will  use 
all  antiseptic  precautions  herself,  and  she  will 
also  guard  well  her  work  against  any  such  dis- 
asters (or  worse)  as  have  already  been  al- 
luded to. 

Surgeons,  themselves,  as  a  rule,  realize  very 
fully  the  grave  responsibility  of  a  life  at  stake ;  The  Debt  We 
but  seldom  do  we  meet  a  careless  one.  They, 
as  well  as  the  world  at  large,  owe  a  debt  of 
gratitude  to  Lord  Lister  for  the  discovery  of 
the  possibility  of  the  overthrow  of  the  power  of 
sepsis  through  the  use  of  antiseptics. 

STERIIZATION  AND  DISINFECTION.  We 
often  hear  the  terms  sterilization  and  disinfec-  Sterilization. 
tion  used  interchangeably  as  expressive  of  the 
same  meaning,  which,  strictly  speaking,  is  not 
accurate.  When  we  sterilize  anything  we  are 
supposed  completely  to  destroy  the  vitality  of 
107 


Disinfection. 


Antiseptics. 


Germicides. 


Deodorants. 


BACTERIOLOGY  IN  A  NUTSHELL. 

all  bacteria  present,  either  within,  or  upon  the 
substance  sterilized.  The  process  of  steriliza- 
tion is  accomplished  by  the  proper  application 
for  a  stated  period  of  either  chemical  agents  or 
heat. 

In  order  to  disinfect  anything  we  do  not 
necessarily  destroy  all  the  bacteria  present,  but 
only  those  that  are  harmful,  because  of  their 
power  to  create  disease — power  to  infect,  in 
other  words. 

Certain  substances  used  to  prevent  the 
growth  of  bacteria,  but  which  may  not  neces- 
sarily destroy  them  are  called  antiseptics.  An 
antiseptic  does  not  always  possess  the  power  to 
disinfect,  but  a  disinfectant  is  always  an  anti- 
septic. 

Germicides  and  disinfectants  are  inter- 
changeable terms  because  they  both  possess  the 
power  to  destroy  disease-producing  germs. 

Deodorants  are  substances  or  agents  used  to 
destroy  offensive  odors;  they  are  not  of  neces- 
sity disinfectants,  but  they  may  be.  Creolin, 
lysol,  formalin  and  carbolic  acid  are  all  both 
deodorants  and  disinfectants,  while  such  de- 
odorants as  Eau  de  Cologne  and  violet  extract 
have  no  power  to  disinfect. 


108 


DISINFECTANTS HOW  MOST  EFFECTIVE. 

VARIOUS    CONDITIONS    MODIFY    THE    POWER    OF 

DISINFECEANTS. 

• 

I. — The  kind  of  bacteria  we  wish  to  destroy. 
Some  are  more  difficult  to  kill  or  to  render  Conditions 
powerless  to  do  mischief  than  others.     Spores  Powc?ofg 
are  found  much  harder  to  deal  with,  as  was  Disinfectants. 
spoken  of  in  describing  their  formation,  than 
the  bacteria  from  which  they  spring. 

II. — The  number  of  bacteria  to  be  destroyed. 
If  a  large  number  are  present  more  of  the  solu- 
tion is  necessary  than  for  a  small  number. 
Completely  saturate  the  mass  always,  for  what- 
ever number. 

III. — The  temperature  and  strength  of  the 
solution.  Hot  disinfectants  are  more  effective 
than  warm  or  cold  disinfectants;  in  fact,  all 
disinfectants  should  be  used  hot. 

IV. — Material  with  which  a  solution  may 
come  in  contact.  If  some  disinfectants  come 
in  contact  with  organic  matter,  they  are  rend- 
ered of  little  or  no  value  thereby.  The  writer 
remembers  seeing  a  pupil  nurse  sent  three  times 
to  empty  out  and  prepare  anew  a  disinfectant  An  Assistant's 
solution  because  an  assistant  put  his  soiled  Mistake- 
finger  into  the  first  two,  in  order  to  test  the 
temperature,  and  was  about  to  make  the  same 
blunder  a  third  time  when  prevented  by  the 
whispered  admonition  of  the  head  nurse.  The 
lesson  is  plain. 

109 


BACTERIOLOGY  IN  A  NUTSHELL. 

Plot  air,  steam  or  boiling  water,  are  all  dis- 
infectants or  germicides.  The  value  of  hot  air 
or  dry  heat  as  a  disinfectant  is  limited,  as  there 
are  so  many  things  which  cannot  be  disinfected 
by  either  without  being  injured.  Moist  heat 
is  more  penetrating  than  hot  air,  and  mat- 
tresses, clothing,  and  surgical  instruments  can 
all  be  treated  by  moist  heat  without  sustaining 
injury.  Clothing  stained  with  pus,  or  fecal 
matter,  should  not  be  disinfected  with  steam 
heat,  as  the  stains  will  be  found  difficult,  if  not 
impossible,  to  remove  afterward. 

Boiling  water  is  warranted  to  destroy  ail 
known  bacteria  or  their  spores  if  exposed  to  its 
power  for  a  sufficient  period,  and  provided, 
also,  that  a  sufficient  quantity  is  used. 

INTERMITTENT  STERILIZATION.  By  inter- 
Definition,  mitent  sterilization  we  mean  the  exposure  of 
articles  to  be  sterilized  to  the  action  of  live 
steam  for  one  hour  on  three  successive  days. 
Certain  spores  are  known  to  retain  germinating 
powers  after  being  treated  to  a  bath  of  boiling 
water,  and  the  end  sought  in  intermittent  steril- 
ization is  to  destroy  all  bacteria  which  may 
develop  from  spores  after  the  first  or  second 
sterilization.  The  process  is  only  rarely  neces- 
sary, because  exposure  to  live  steam  for  one 
hour  usually  kills  both  bacteria  and  spores. 

In  aseptic  surgery  many  consider  the  use  of 
both  heat  and  chemicals  necessary  in  order  to 
no 


ASEPTIC   MEASURES. 

insure  freedom  from  all  pathogenic  bacteria 
and  their  spores.  This  applies  only  to  the  Aseptic. 
preparation  of  dressings,  sponges  and  the  skin, 
except  in  diseased  conditions.  "Clean  healthy 
tissue  contains  no  bacteria."  ''Wounds  in 
healthy  tissue  tend  to  heal  spontaneously." 

"Antiseptics  being  all  more  or  less  irritant 
tend  to  interfere  with  the  healing  process." 

If  a  healthy  wound  is  properly  protected 
,  .„:.,.  *'.*  .  Infection  of 

from  possible  invasion  of  micro-organisms,  the  Healthy 

use  of  antiseptics  is  unnecessary  and  may  be  Wounds- 
injurious.     Infection  may  reach  the  wound  in 
several  ways : 

I. — Because  the  room  in  which  the  operation 
is  performed  is  not  properly  prepared,  or  if 
sweeping  or  dusting  is  done  just  when  the 
wound  is  to  be  uncovered  for  dressing.  Dust 
must  always  be  wiped  up  in  sick-rooms  with  a 
cloth  wrung  out  of  a  disinfectant  solution. 

II. — Use  of  water  not  sterilized,  or  not  kept  Never  Dust 
covered  after  sterilization,  when  it  asrain  be-  With  a  Dry 

"-- 

comes  filled  with  micro-organisms. 

III. — If  the  skin  of  the  patient  has  not  been 
made  aseptic  prior  to  the  operation.  No  mat- 
ter how  cleanly  a  person  may  be,  the  skin,  the 
hair  follicles,  and  sweat  glands  all  harbor  bac- 
teria, and  if  not  properly  attended  to  these  may 
invade  the  wound.  (Ordinary  cleanliness  is 
not  "surgical  cleanliness.") 
in 


BACTERIOLOGY  IN  A  NUTSHELL. 

IV. — The  hands  of  the  surgeon  or  nurse  may 
cause  the  trouble. 

V. — Instruments,  drainage,  the  clothing  of 
Responsibility  patient,  or  operator  or  nurse,  ligatures,  sutures, 
of  the  Nurse.  sponges,  dressings,  towels,  any  of  which  may 
be  infected.  The  nurse's  duty  is  to  guard 
against  danger  of  infection  from  whatever 
source.  After  careful  cleansing,  drainage  tubes 
must  be  boiled  for  an  hour  on  three  successive 
days  and  kept  between  times  and  until  needed 
for  use  in  a  75%  solution  of  alchohol.  Boil 
again  for  ten  minutes  just  prior  to  using.  In- 
sert the  sterile  gauze  packing  required  by  most 
surgeons  and  fold  the  tubing  in  a  sterile  towel 
ready  for  use  when  called  for.  Gauze  sponges, 
dressings,  towels,  gowns,  etc.,  should  be  placed 
in  separate  packages,  plainly  marked  and  ex- 
posed to  the  influence  of  live  steam  in  a  high 
pressure  sterilizer  for  thirty  minutes  on  three 
successive  days.  They  must  not  be  opened 
until  they  are  required  for  use.  Ligatures  and 
sutures  should  be  loosely  wound  on  glass  spools 
and  placed  in  test  tubes  plugged  with  sterile 
cotton  before  placing  in  the  sterlizer.  The  cot- 
ton plugs,  unless  made  too  firm,  will  permit 
the  entrance  of  sufficient  heat  to  sterilize  the 
material.  Always  keep  sutures  and  ligatures 
in  sterile  tubes  closely  plugged  when  not  in  use, 
and  place  these  in  tightly  closed  sterile  glass 
jars.  Gauze  sponges  should  have  no  raw 

112 


ASEPTIC    MEASURES. 

edges  exposed.  When  properly  made  they  are 
folded  upon  themselves  and  all  raw  edges 
turned  in. 

A  careful  nurse  never  makes  a  mistake  in 
the  number  of  abdominal  sponges  she  has  in 
use  during  an  operation. 

Catgut  requires  much  preparation  in  order 
to  make  it  safe.  Many  surgeons  prefer  to  use 
catgut  which  is  scientifically  prepared  in  large 
laboratories;  this  is  put  up  in  specially  con- 
structed tubes,  which  are  not  opened  until  re- 
quired for  use.  Even  these  would  better  be 
sterilized  again  prior  to  the  operation. 

• 

DISINFECTION   AND  DISINFECTANTS. 

No.  i.  HAND  DISINFECTION. — First, 
cleanse  the  hands  (including  the  arms  above  Precautions 
the  elbows)  with  plenty  of  antiseptic  soap  and 
hot  water,  using  a  sterile  brush  vigorously  for 
ten  minutes,  especially  for  the  nails,  beneath 
which  germs  lurk.  Second,  clean  the  nails 
thoroughly  with  a  nail  knife  or  file,  to  remove 
any  bacteria  the  nail  brush  may  have  left  be- 
hind. Third,  wash  the  hands  again,  as  the 
nail  cleaning  process  may  have  deposited  par- 
ticles of  dirt  containing  germs  on  the  hands. 
Fourth,  soak  the  hands  and  arms  for  several 
minutes  (3  to  5)  in  a  solution  containing  about  and  Arms.  S 
twenty  grains  potassium  permanganate  to  each 
113 


BACTERIOLOGY  IN  A  NUTSHELL. 

pint  of  water,  and  then  in  another  solution  of 
oxalic  acid  (saturated  solution),  soaking  the 
hands  for  the  same  length  of  time.  The  po- 
tassium permanganate  is  a  good  germicide,  un- 
less it  comes  in  contact  with  organic  matter, 
and  oxalic  acid  is  a  still  better  one;  it  also 
removes  from  the  hands  the  brown  stain  of  the 
potassium  permanganate.  Fifth,  soak  the 
hands  and  arms  in  alcohol,  and  again  in  hot 
sterile  water.  The  alcohol  as  a  further  pre- 
caution against  bacteria,  and  the  sterile  water 
to  relieve  the  irritation  caused  by  the  vigorous 
scrubbing  and  use  of  strong  solutions.  During 
operation  use  alcohol,  bichloride  of  mercury 
solution,  1-8,000,  and  sterile  water  for  further 
protection. 

No.  2.     HAND  DISINFECTION. — Some  sur- 

Alcohol  and  geons  use  alcohol,  followed  by  bichloride  solu- 

Bichloride  * 

Preferred.  tion  and  hot  sterile  water,  applied  in  the  same 

way  as  the  permanganate  and  oxalic  acid  are 
used  after  the  vigorous  scrubbing  with  brush, 
soap  and  water  and  use  of  nail  knife  recom- 
mended in  No.  i.  There  are  various  other 
methods  of  hand  disinfection. 

No.  3.  HAND  DISINFECTION. — This  method 
has  given  uniformly  good  results. 

I. — Five  to  ten  minutes  thorough  washing 
and  scrubbing  with  green  soap  and  hot  water, 
using  a  sterile  nail  brush  vigorously,  especially 

114 


HANDS   AND   INSTRUMENTS,    ETC. 

about  the  finger  nails,  and  drying  with  a  sterile 
towel. 

II. — Careful  cleaning  and  clipping  of  nails 
with  nail  file  and  knife. 

III. — A  second  washing  of  hands  with  soap 
and  hot  water  for  further  cleansing  from  nail 
deposits. 

IV. — Chloride  of  lime  paste  is  next  well 
rubbed  into  hands  and  nails,  and  well  rinsed  off 
in  a  soda  carbonate  solution. 

V. — Soaking  of  hands  two  to  three  (2  to  3) 
minutes  in  a  bichloride  of  mercury  solution 
1-4,000,  followed  by  hot  sterile  water. 

During  operation  use  frequently  for  the 
hands  a  bichloride  of  mercury  solution  1-4,000, 
followed  by  sterile  water  as  a  precautionary 
measure.  In  the  most  up-to-date  hospitals 
surgeons  and  their  assistants  and  the  nurses 
who  have  charge  of  the  instruments  and  dress- 
ings during  surgical  operations,  are  now-a- 
days  using  face  masks  as  well  as  rubber  gloves. 
Those  who  as  yet  have  not  adopted  the  face 
mask  tie  several  folds  of  gauze  over  the  mouth, 
the  saliva,  even  of  the  most  healthy,  has  been 
proven  to  contain  pathogenic  bacteria.  A 
slight  cough  may  eject  the  saliva  upon  the 
field  of  operation  with  disastrous  consequences 
to  the  patient. 

To  DISINFECT  SURGEONS'  SCALPELS  AND 
INSTRUMENTS  : — First,  cleanse  instruments  and 


BACTERIOLOGY  IN  A  NUTSHELL. 


Thorough 
Cleansing 
Required. 


Watch  Your 
Scalpels. 


Cover 

Instruments 

Quickly. 


scalpels  thoroughly,  paying  particular  atten- 
tion to  all  crevices  and  hollow  parts.  Wrap 
the  blades  of  the  scalpels  in  cotton  and  place  in 
a  separate  tray  above  the  tray  in  which  you 
place  the  other  instruments,  as  scalpels  must 
only  be  boiled  two  minutes,  to  prevent  dulling 
their  edges.  Place  both  trays  in  the  sterilizer 
in  which  water  is  boiling  (the  water  should 
contain  a  small  quantity — 2% — of  carbonate 
of  soda).  Boil  all  instruments  except  scalpels 
or  bistouries  twenty  minutes.  Remove  from 
the  sterilizer  and  place  immediately  in  a  five  per 
cent  ($%)  solution  of  carbolic  acid,  covering 
the  receptacle  with  a  sterile  towel,  unless  the 
surgeon  prefers  to  use  his  instruments  dry, 
which  many  do ;  in  this  case  they  are  placed  in 
a  sterile  receptacle  and  covered  as  quickly  as 
possible.  The  same  process  of  cleansing  and 
sterilizing  should  be  adopted  after  an  opera- 
tion ;  they  must  be  wiped  dry  with  a  sterile  in- 
strument cloth  before  returning  to  the  instru- 
ment closet. 

The  method  of  sterilizing  instruments 
adopted  by  some  hospitals  is  to  wrap  the  in- 
struments in  a  sterile  towel  after  cleansing 
thoroughly,  and  then  to  expose  them  to  the  in- 
fluence of  live  steam  for  a  stated  period ;  about 
thirty  minutes. 

To  DISINFECT  SPUTA  AND  SPUTA  CUPS: — 
Pour  into  the  cups  sufficient  hot  five  per  cent 
116 


SPUTA,    CLOTHING,    BEDS,   BEDDING,    ETC. 

( 5  % )    carbolic  acid  solution  to   saturate  the  Ug     f 

contents  of  the  cup.     Add  a  small  quantity  of  Carbonate. 

carbonate  of  soda  (common  washing  soda)  to 

loosen  the  sputa  from  the  sides  and  bottom  of 

the  cup;  cover  and  allow  to  stand  until  cold 

before  emptying.     The  cups   should  be   well 

cleansed   and  boiled   once  a   day   in   a   soda-  c°ps  puta 

carbonate  solution,  particularly  the  sputa  cups 

of  tuberculosis  patients. 

To  DISINFECT  CLOTHING,  BEDS,  BEDDING 
AND  FURNITURE  : — Personal  clothing,  towels 
and  bed  linen  used  in  the  care  of  communicable 
diseases  must  be  soaked  for  two  o,r  more  hours 
in  a  proper  disinfectant  solution  (carbolic  acid, 
sol.  five  per  cent   ($%)   is  good),  and  then 
thoroughly  washed.     Dry  in  the  outdoor  air 
and  sunshine.     Mattresses  and  pillows  should 
be  exposed  to  the  influence  of  live  steam  for  a 
sufficient  length   of   time   to   do   good   work. 
When  there  is  no  apparatus  for  the  steaming 
process,    wash    the    surfaces    of    pillows    and  outdoor  Air 
mattresses  with  the  disinfectant  solution,  turn  in  Disinfection, 
over  the  foot-boards  of  the  beds  in  rooms  or 
-  wards  to  be  fumigated,  so  that  the  substance 
used  for  fumigation  may  reach  them  from  all 
sides.     To  complete  the  process,  put  them  out 
in  the  fresh  air  and  sunshine  for  twenty-four  Exposure 
hours.     Mattresses  stained  with  typhoid  fever  from  a11  Sides* 
defecations  would  better  be  burned. 
Beds,  windows,  walls,  floors,  woodzvork  and 
117 


BACTERIOLOGY  IN  A  NUTSHELL. 


Leave  Bureau 
and  Other 
Drawers  Open. 


Removal 
of  Odors. 


Reversible 

Rubber 

Sheeting. 


all  pieces  of  furniture  first  must  be  cleansed 
with  soap  and  hot  water  and  then  washed  with 
the  disinfectant  solution.  Bureau  and  stand 
drawers  should  be  treated  in  a  similar  way,  and 
left  open  for  fumigation.  If  floor  rugs  are 
used  they  should  be  wiped  off  with  the  solu- 
tion, and  both  sides  exposed  to  the  fumes  of 
formaldehyde  or  other  substance  just  as  recom- 
mended for  mattresses.  Then  they  should  be 
hung  up  and  well  beaten  in  the  open  air,  and 
left  there  for  twenty- four  hours  also. 

To  DISINFECT  RUBBER  SHEETS: — First, 
wash  clean  in  hot  water  with  soap  and  brush, 
rinse  in  clear  water  and  soak  one  hour  in 
carbolic  acid  five  per  cent  ($%)  solution,  or 
other  good  solution.  Wipe  dry  and  hang  out 
in  the  fresh  air  and  sunlight  to  remove  any 
odor  than  that  of  rubber.  Sheeting  with  the 
rubber  preparation  on  either  side  (reversible), 
is  the  best  and  safest  in  nursing  communicable 
diseases.  The  disinfecting  can  be  more 
thoroughly  accomplished,  and  the  sheets  look 
safe.  This  sheeting  makes  a  good  covering 
for  all  vessels  used  for  evacuations,  etc.,  to  be 
disinfected. 


SUMMARY  OF   CHAPTER  VI. 

Bacteria  in  surgery.     Cases  in  which  they 
are  found. 

Sepsis,  its  cause,  the  germ  found  in  sepsis. 
118 


SUMMARY    AND    REVIEW. 

Why  there  should  be  no  cases  of  sepsis  in  the 
present  age.  Why  sepsis  is  so  much  to  be 
dreaded. 

The  "everlasting  and  eternal  vigilance" 
necessary  in  surgical  work  and  nursing.  The 
dangers  to  be  guarded  against.  What  may 
come  of  blunders  in  surgery  and  in  obstetrics. 

Responsibility  recognized  by  most  surgeons 
as  too  great  to  be  trifled  with. 

The  nurse's  responsibility  should  be  ever 
uppermost  in  her  thoughts. 

Sterilization.  Disinfection.  Antiseptics. 
Germicides.  Deodorants. 

Conditions  which  may  lessen  the  power  of 
disinfectants. 

Heat  as  a  germicide.  Intermittent  steriliza- 
tion. 

Aseptic  surgery.  The  precautions  necessary 
to  prevent  infection  from  reaching  healthy 
tissues. 

QUESTIONS  FOR  REVIEW CHAPTER  VI. 

I. — W'hat  germs  are  most  commonly  met 
with  in  surgery?  What  cases  are  they  most 
likely  to  attack? 

II. — What  germ  do  physicians  most  fear  in 
a  certain  class  of  accidental  wounds? 

III. — Define  sepsis,  asepsis,  antisepsis.  What 
germ  is  said  to  be  responsible  for  the  disease 
sepsis?  How  does  it  gain  an  entrance  to  the 


BACTERIOLOGY  IN  A  NUTSHELL. 

human  structure  ?  Is  it  easily  overcome  ?  De- 
scribe the  symptoms  of  sepsis.  Seat  of  in- 
vasion in  sepsis. 

IV. — Describe  in  detail  the  work  of  the 
nurse  in  guarding  sources  of  infection  before, 
during  and  after  operations  and  in  obstetrics. 

V. — Define  sterilization  and  disinfection. 
Antiseptics.  Germicides.  Deodorants.  Are 
germicides  and  disinfectants  interchangeable 
terms  ? 

VI. — Give  an  accurate  explanation  of  the 
conditions  modifying  the  power  of  disinfect- 
ants. 

VII. — What  do  you  know  of  intermittent 
sterilization?  Explain  where  its  use  is  ad- 
vised. 

VIII. — Define  aseptic  surgery.  What  do 
many  surgeons  consider  necessary  adjuncts  to 
safety  in  the  practice  of  aseptic  surgery.  De- 
scribe in  detail  the  precautions  you  would 
observe  in  protecting  healthy  wounds  from  in- 
fection. 


120 


CHAPTER  VII. 

SOLUTIONS,     THEIR     USES     AND     PREPARATION. 

IODINE  SOLUTION  : — Harrington's  solution 
of  iodine  is  an  antiseptic  rapidly  growingrin 
popular  favor.  Strength  used,  i-ioo  and 
1-500.  This  solution  is  believed  by  many  to 
be  the  best  antiseptic  now  in  use  for  any  pur- 
pose. 

CARBOLIC  ACID  SOLUTION  AS  A  DISINFECT- 
ANT : — Carbolic  acid  solution  may  be  safely 
used  for  the  disinfection  of  personal  clothing, 
bedding,  excreta,  surgical  instruments  and 
appliances.  It  cannot  be  relied  upon  to  de- 
stroy spores,  and  therefore  should  not  be  used 
as  a  disinfectant  in  tetanus,  anthrax,  malignant 
oedema,  or  in  any  disease  due  to  invasion,  of 
spore-forming  bacteria.  A  one  per  cent, 
strength  solution  is  said  to  be  sufficiently  strong 
to  destroy  the  germs  of  cholera,  typhoid  fever, 
diphtheria  and  erysipelas  if  used  hot  in  suf- 
ficient quantity,  and  allowed  to  stand  an  hour, 
so  as  to  completely  saturate  the  material  to  be 
disinfected. 

A  five  per  cent  (1-20)  solution  is  necessary 
in  surgical  practice,  in  order  to  be  reliable. 
Fifty-one  drams  of  liquid  carbolic  acid  dis- 
solved in  each  gallon  of  water  makes  a  five  per 

121 


BACTERIOLOGY  IN  A  NUTSHELL. 

cent  solution.  Pour  boiling  water  over  the 
carbolic  acid  and  mix  thoroughly.  To  make  a 
small  quantity  of  a  five  per  cent  (5%)  sol. 
carbolic  acid  ( 1-20)  add  one  dram  of  the  liquid 
to  nineteen  drams  of  water.  (See  table  at 
close  of  Chapter  VII.  for  number  of  grains  to 
each  pint.) 

BICHLORIDE  OF  MERCURY  solution  will  de- 
stroy all  forms  of  bacteria  and  their  spores. 
Strength  1-500  required  for  spores — exposure 
one  hour.  Bichloride  of  mercury  is  not  re- 
liable for  the  disinfection  of  excreta,  sputum  or 
pus,  because  of  its  power  to  precipitate  an 
albuminous  deposit,  which  forms  a  coating 
around  the  substance  and  prevents  the  solution 
from  penetrating  the  mass.  It  is  a  good  dis- 
infectant for  rooms.  It  is  also  used  in  hand 
disinfection  and  as  a  wet  pack  or  dressing  in 
various  forms  of  inflammation.  It  ruins  in- 
struments or  anything  in  the  shape  of  metals. 

In  making  up  bichloride  of  mercury  solu- 
tions, tablets  containing  seven  and  a  half  grains 
are  often  used.  One  of  these  tablets  added  to 
one  pint  of  water  makes  a  1-1,000  solution. 
One  to  a  quart  a  1-2,000  solution;  1-1,000  is 
the  strongest  solution  used  for  almost  any  pur- 
pose. Water  is  added  to  obtain  the  weaker 
solutions  generally  used.  For  example,  if  you 
have  a  quart  of  1-1,000  solution  prepared  and 
the  doctor  asks  for  three  quarts  of  1-4,000  so- 
122 


SOLUTIONS USES  AND  PREPARATION  OF. 

lution,  add  three  quarts  of  warm  sterile  water 
to  your  quart  of  1-1,000  solution,  and  you  will 
have  the  desired  strength.  If  only  a  small 
quantity,  say  one  pint  of  the  solution  1-4,000 
is  needed,  take  four  ounces  of  the  1-1,000  solu- 
tion and  add  to  it  twelve  ounces  of  water  of 
the  required  temperature.  In  using  the  bi- 
chloride of  mercury  powder  (corrosive  subli- 
mate), dissolve  seven  and  one-fourth  grains 
(grs.  7^4)  in  each  pint  of  water. 

Sublimine,  which  is  another  preparation  of 
mercury,  called  ethylenediamin-sulphate  of 
mercury,  is  used  for  all  purposes  in  which 
bichloride  of  mercury  solutions  are  used.  It 
is  considered  by  some  to  be  less  irritating  than 
bichloride  of  mercury  and  alcohol  to  remove 
oily  substances  from  the  skin  prior  to  its  use  as 
a  disinfectant  is  unnecessary.  Strength  of  so- 
lutions from  i- 10,000  up  to  1-300. 

PEROXIDE  OF  HYDROGEN  (Hydrogen  Diox- 
ide), also  called  "dioxygen,"  is  considered  by 
many  surgeons  to  have  no  equal  either  for 
safety  or  efficiency  in  treating  cavities  or  sur- 
faces secreting  pus.  This  preparation  must  be 
kept  tightly  corked,  as  it  will  otherwise  deter- 
iorate in  value  very  rapidly,  and  in  a  cool,  dark 
place ;  heat  and  light  spoil  the  preparation. 

INTESTINAL  EVACUATIONS  may  be  safely 
disinfected  by  pouring  upon  them  three  times 
their  quantity  of  boiling  water.  Cover  and 
123 


BACTERIOLOGY  IN  A  NUTSHELL. 

allow  to  get  cold  before  disposing  of  them. 
Milk  of  lime  made  from  freshly  slaked  lime  is 
also  a  safe,  cheap  disinfectant  for  excreta.  It 
should  remain  in  contact  with  the  exacuation 
for  several  hours.  Freshly  slaked  lime  must 
be  used  in  preparing  this  solution.  To  slake 
the  lime,  pour  one  pint  of  water  over  two 
pounds  of  lime.  When  dissolved  mix  thor- 
oughly. This  preparation  is  also  called 
"hydrate  of  lime."  To  make  the  "milk  of 
lime"  solution,  use  one  pound  of  hydrate  of 
lime  to  eight  pints  of  water.  Contact  with  the 
air  spoils  this  solution,  renders  it  inert,  and  for 
this  reason  it  should  be  made  anew  every  two 
days. 

LYSOL  is  a  good  antiseptic,  especially  so  as  it 
is  non-irritant.  It  can  be  used  to  disinfect 
almost  everything  in  the  sick-room. 

It  is  used  also  for  irrigation  purposes;  for 
disinfection  of  skin  prior  to  operations;  for 
hand  disinfection,  e,tc.  Usually  a  two  per  cent 
solution  is  required.  When  using  the  liquid 
lysol  a  two  per  cent  solution  can  be  made  by 
dissolving  two  and  one-half  fluid  ounces  of  the 
drug  in  one  gallon  of  water.  For  dressings 
prior  to  operation,  one-half  per  cent  solution 
is  used.  (For  number  of  grains  required  in 
making  up  solutions,  see  table.)  Tricresol, 
solutol  and  solveol  are  among  the  most  valuable 
disinfectants  of  the  present  day.  They  all  de- 
124 


SOLUTIONS USES  AND  PREPARATION  OF. 

stroy  spores  and  are  not  open  to  the  objection 
raised  against  bichloride  of  mercury  with  re- 
gard to  albuminous  deposits.  They  belong  to 
the  same  family  as  lysol  and  are  known  as  the 
creosols.  Tricresol  is  accounted  as  'the  best 
disinfectant  of  the  group,  solutol,  solveol  and 
lysol  following  in  value  in  the  order  named. 
i  to  5%  solutions  are  required  in  order  to  be 
effectual. 

CREOLIN  is  another  antiseptic  used  as  a  dis- 
infectant for  the  hands,  and  also  for  the  pur- 
pose of  irrigation.  A  five  per  cent  solution  is 
sufficiently  strong,  as  a  rule. 

POTASSIUM  PERMANGANATE  is  a  fairly  good 
disinfectant,  but  its  application  is  limited,  be- 
cause its  action  is  so  quickly  rendered  inert  by 
contact  with  organic  matter.  It  also  stains  a 
yellowish  brown  any  object  which  it  touches, 
and  the  stain  requires  the  application  of  an  acid 
to  remove.  It  is  used  quite  extensively  as  a 
deodorant  in  offensive  wounds,  for  hand  dis- 
infection and  to  irrigate  cavities.  Sixteen  to 
twenty  grains  of  the  potassium  permanganate 
crystals  to  each  pint  of  water  is  the  strength  of 
the  solution  generally  used.  Oxalic  acid  (a 
saturated  solution)  is  frequently  used  to  re- 
move the  stain  of  potassium  permanganate.  It 
is  considered  to  be  a  more  powerful  germicide 
than  permanganate  of  potassium,  but  it  is  de- 
cidedly irritant  in  its  effects. 


BACTERIOLOGY  IN  A  NUTSHELL. 

NORMAL  SALT  SOLUTION  is  a  very  valuable 
antiseptic.  As  a  douche  and  enema  it  is  well 
known.  It  is  also  used  in  intravenous,  subcu- 
taneous and  rectal  injections,  for  its  stimulat- 
ing effects  after  hemorrhage  in  various  dis- 
eases ;  in  shock  during  or  after  surgical  opera- 
tions; in  toxemia  from  any  cause.  A  pint  of 
the  solution  is  frequently  given  by  rectal  in- 
jection an  hour  or  two  before  a  surgical  opera- 
tion, as  its  use  serves  to  lessen  the  possibility  of 
shock,  and  also  assists  in  preventing  the  thirst 
from  which  patients  so  often  suffer  after  surg- 
ical operations.  0.6  per  cent  is  the  strength 
used.  The  solution  is  made  by  dissolving  one 
dram  of  common  salt  in  each  pint  of  hot  water. 
Sterilize  in  a  covered  vessel  before  using,  ex- 
cept where  used  as  a  rectal  injection,  when 
sterilization  is  not  necessary.  When  used  in- 
travenously, or  subcutaneouslj,  it  must  always 
be  sterilized*  The  intravenous  injections  are 
never  given  by  the  nurse,  as  it  is  a  method  con- 
fined to  the  physician  alone.  It  is  used  during 
operations  very  often,  or  immediately  after 
operations,  when  there  has  been  much  loss  of 
blood,  or  where  the  patient  is  suffering  from 
shock,  in  order  to  "furnish  sufficient  fluid  to 

*  Sterilize  the  syringe,  canula,  suture,  thermometer 
for  testing  the  temperature  of  the  solution  (which 
should  be  115°  to  120°  F.),  scissors,  and  everything  in 
the  shape  of  instruments  by  boiling  in  soda  carbonate 
solution.  For  the  intravenous  injections,  thoroughly 
scrub  and  sterilize  the  area  to  be  used. 
126 


SOLUTIONS USES  AND  PREPARATION  OF. 

suspend  the  remaining  red  blood  cells  for  cir- 
culation through  the  system,  and  to  restore  a 
normal  amount  of  circulating  fluid  for  the 
heart  and  arteries  to  act  upon."  For  wet  dress- 
ings, packs,  purposes  of  irrigation  and  for 
soaking  of  wounds  or  incisions  after  surgical 
operation  in  septic  and  other  cases,  no  better 
solution  than  normal  saline  has  yet  been  dis- 
covered. In  point  of  fact,  it  has  few  equals. 

WHEN  PREPARING  FOR  AN  OPERATION  the 
nurse  can  make  up  a  salt  solution  containing 
two  ounces  of  common  salt  to  one  pint  of  hot 
water;  sterilize  the  solution  by  boiling  five  to 
ten  minutes,  after  filtering.  Keep  in  a  tightly 
closed  sterile  jar.  One  ounce  of  this  solution 
added  to  each  pint  of  sterile  water  is  the  re- 
quired strength  for  all  injections  necessary 
when  the  patient  is  suffering  from  shock,  ex- 
haustion, or  other  causes  in  which  normal  salt 
is  called  for.  It  should  be  made  anew  for  each 
operation. 

FORMALIN  SOLUTION.  A  four  per  cent 
solution  of  formalin  is  considered  to  be  as  effec- 
tive as  bichloride  of  mercury  solution  1-1,000, 
or  as  carbolic  acid  solution  1-20  (5%). 
Formalin  contains  formaldehyde  forty  per  cent 
and  wood-alcohol  ten  per  cent.  Unlike  bi- 
chloride of  mercury  it  does  not  deposit  album- 
inous substances  in  solution,  but  it  destroys 
iron,  steel  or  other  metal  quite  as  effectually. 
127 


BACTERIOLOGY  IN  A  NUTSHELL. 

The  four  per  cent  solution  is  prepared  by  add- 
ing forty-one-drams  to  each  gallon  of  water.  It 
destroys  spores  and  can  be  used  safely,  also,  to 
disinfect  excreta,  urine,  pus,  etc.  (For  num- 
ber of  grains  to  use  for  each  pint  of  solution 
see  table  at  close  of  Chapter  VII.) 

BORACIC  ACID  is  a  mild,  non-irritating  anti- 
septic used  freely  in  irrigation  and  in  surgery 
of  the  eye  and  ear.  Many  surgeons  use  a  sat- 
urated solution ;  others  prefer  a  solution  of  one 
dram  to  each  pint  of  water.  It  is  dissolved  by 
pouring  boiling  water  over  the  acid  powder. 
It  does  not  dissolve  readily  in  warm  water.  In 
fact  it  would  better  be  boiled.  In  making  the 
saturated  solution,  it  has  been  found  that  only 
about  eighteen  grains  of  the  powder  to  each 
ounce  of  water  is  soluble  in  water  alone. 

THE  AMERICAN  STANDARD.  A  solution 
known  as  the  "American  Standard"  is  made 
by  dissolving  six  ounces  of  chloride  of  lime  in 
one  gallon  of  water.  It  is  said  to  be  valuable 
in  the  disinfection  of  excreta.  Chloride  of  lime 
in  order  to  be  reliable  must  be  purchased  of  a 
reliable  mannufacturer. 

THIERSCH'S  SOLUTION.  In  the  preparation 
of  this  solution,  which  is  often  used  as  an  anti- 
septic for  purposes  of  irrigation,  add  one  and  a 
half  ounces  of  boracic  acid  and  two  drams  of 
salicylic  acid  to  one  gallon  of  water.  Dissolve 
the  acids  in  hot  water  and  sterilize  before  using. 
128 


SOLUTIONS USES  AND  PREPARATION  OF. 

BALSAM  OF  PERU.  A  five  to  ten  per  cent  solu- 
tion of  balsam  of  Peru  is  an  antiseptic  solution 
frequently  used  in  dressing  burns  and  other 
wounds.  The  balsam  is  combined  with  castor 
oil  or  glycerine  as  a  base.  Balsam  of  Peru, 
five  per  cent,  and  castor  oil  ninety-five  per  cent, 
is  the  common  formula. 

These  are  a  few  of  the  best  drugs  for  anti- 
septic and  disinfectant  purposes  now7  in  use. 
New  drugs  for  the  same  uses  are  being  discov- 
ered every  year. 

STERILE  WATER.  As  sterile  water  alone  is 
so  frequently  used  in  aseptic  surgery,  its  prep- 
aration should  be  understood  even  by  nurses 
just  entering  the  work.  The  water  should  first 
be  filtered  and  then  boiled  in  vessels*  which 
have  also  been  made  thoroughly  clean  by  wash- 
ing and  soaking  in  an  antiseptic  solution,  or 
better  still,  by  boiling.  Distilled  water  ought 
to  be  aseptic,  but  as  those  who  distill  it  are  apt 
to  handle  it  carelessly,  nurses  are  advised  to 
boil  even  distilled  water  before  using  it  for 
aseptic  sugery. 

FILTERED  WATER. 

FILTERED  WATER  is  not  considered  safe  to 
use  for  drinking  or  surgical  purposes  without 
sterilizing.  The  parasitic  bacteria  filter 

*  Filtered  water  and  salt  solutions  are  preferably 
sterilized  in  their  containers  and  kept  therein  tightly 
closed  until  used. 

129 


BACTERIOLOGY  IN  A  NUTSHELL. 

through  any  ordinary  filtering  apparatus,  the 
process  of  filtration  only  ridding  the  water  of 
other  impurities  and  making  it  transparent.  A 
system  of  sand  filtration  is  in  use  in  some  cities. 
By  means  of  the  sand  the  parasitic  bacteria  are 
held  in  abeyance  until  destroyed  by  the  sapro- 
phytic. 

ALCOHOL  is  used  in  skin  sterilization  for  the 
purpose  of  removing  oily  substances,  which 
prevent  the  penetration  of  some  other  disin- 
fectants. Ether  is  used  for  the  same  reason. 

SULPHUR    DIOXIDE    FUMIGATION. 

To  use  sulphur  for  fumigation,  take  about 

To  Fumigate  four  pounds  of  rock  sulphur  (brimstone)  for 

With  Sulphur.         each  one  thousand   cubic   feet   of  space      An 

apertures  and  crevices  about  transoms,  doors 
or  windows,  etc.,  must  be  well  packed  with 
damp  absorbent  cotton,  or  batting,  or  strips  of 
old  muslin,  to  prevent  the  escape  of  the  gas. 
Paste  paper  over  openings  of  grates  or  regis- 
ters, key  holes  and  speaking  tubes.  Place  an 
agate-ware,  or  other  metal  basin  or  tub,  half- 
filled  with  water  upon  a  firm  foundation  made 
of  several  bricks  built  near  the  center  of  the 
apartment.  Have  the  required  amount  of 
sulphur  on  top  of  some  paper  in  an  iron  kettle 
sitting  in  the  basin  or  tub  of  water.  Pour  over 
the  sulphur  a  few  ounces  of  alcohol.  Set  fire 
130 


SULPHUR FORMALDEHYDE FORMALIN. 

to  the  outer  edge  of  the  paper  and  leave  the 

room  quickly,  as  the  fumes  of  gas  from  sulphur 

are  dangerous  to  many  people.*     Close  and  Danger  from 

lock  the  door,  and  place  a  thick  rug  over  any  Inhalins- 

crevice  that  may  be  at  the  bottom.     Keep  the 

room  closed  for  twenty-four  hours,  then  open 

up    the    doors    and    windows    and    ventilate 

thoroughly.     Floors,   woodwork,   etc.,   should 

be  again  wiped  over  with  a  cloth  wrung  out  of 

carbolic  acid  solution  ($%)  five  per  cent. 

FORMALDEHYDE   FUMIGATION. 

FORMALDEHYDE  is  more  reliable  for  fumiga- 
tion than  sulphur,  and  is  less  dangerous  to  in-  Advantages  of 
spire.  It  is  a  gas  made  by  burning  methyl  Formaldehyde, 
alcohol,  commonly  called  wood-alcohol,  in  a 
specially  constructed  lamp.  One  and  a  half 
pints  of  alcohol  are  required  for  each  one 
thousand  cubic  feet  of  air  space.  The  process 
of  converting  this  amount  of  alcohol  into 
formaldehyde  gas  or  vapor  takes  less  than  two 
hours,  and  the  rooms  or  wards  are  ready  for 
free  ventilation  at  the  expiration  of  eight  hours. 
Observe  the  same  method  of  packing  crevices 
of  doors,  windows,  transoms,  etc.,  and  of  clos- 
ing grate  openings  and  key  holes  as  described 
in  sulphur  fumigation. 

*  The  writer  remembers  an  instance  in  which  a  nurse 
was  almost  suffocated  by  inhaling  sulphur  gas.  She 
thoughtlessly  stepped  back  into  the  room  for  a  forgotten 
article,  and  was  almost  overcome  when  rescued. 


BACTERIOLOGY  IN  A  NUTSHELL. 

Moisture  is  always  necessary  during  the  pro- 
cess of  fumigation  when  using  sulphur  dioxide. 
In  some  hospitals,  potassium  permanganate 
crystals  are  combined  with  formaldehyde  solu- 
tion in  order  to  liberate  gas  more  readily  and 
rapidly.  The  liquid  formaldehyde  is  poured 
over  the  crystals.*  It  is  also  said  to  increase 
the  germicidal  properties  of  the  formaldehyde. 
Formaldehyde  and  sulphur  dioxide  tapers  are 
used  with  good  result  also.  A  wet  sheet  or 
other  moisture  must  be  present  in  the  room  or 
ward  to  be  disinfected  when  using  these  tapers. 
Solidified  formaldehyde  is  a  preparation  recom- 
mended by  many.  A  very  simple,  specially 
constructed  lamp  is  used  for  generating  the 
gas  which  is  liberated  very  rapidly.  Moisture 
in  the  room  or  ward  during  its  use  is  believed 
to  be  unnecessary ;  the  preparation  itself  being 
moist.  It  sometimes  dries  out,  however,  and 
then  water  must  be  added. 

As  so  many  formaldehyde  lamps  are  unre- 
liable, some  have  found  it  more  satisfactory  to 
use  formalin  solution,  which  contains  forty  per 

Some  Lamps  cent  of  formaldehyde.     The  formalin  is  boiled 

Unsatisfactory.  «   .    , 

in  a  special  apparatus  and  the  gas  passed  into 

the  room  to  be  fumigated  by  means  of  a  tube 
inserted  through   a   key-hole   or   other   small 


*For  a  room  fifteen  feet  square,  five  ounces  of 
permanganate  crystals  and  twenty  ounces  of  formalde- 
hyde solution  are  used. 

132 


SULPHUR FORMALDEHYDE FORMALIN. 

opening.  One  gallon  of  the  preparation  will 
supply  sufficient  gas  to  purify  about  twelve 
hundred  cubic  feet  of  air  space. 

THE  SHEET   METHOD  OF  FORMALDEHYDE 
FUMIGATION. 

After  packing  all  crevices  in  the  room  or 
ward  to  be  fumigated,  place  a  dry  sheet  in  a 
pail  and  over  it  pour  one  pint  of  liquid 
fromaldehyde  for  every  one  thousand  (1,000) 
cubic  feet  of  air  space.  Quickly  spread  the 
sheet  over  a  line  previously  stretched  across  the 
room.  Close  and  pack  the  crevices  around 
door  frames  and  transoms.  It  is  asserted  that 
the  liberation  of  the  fumes  all  at  once  accom- 
plishes the  work  of  disinfection  more  thor- 
oughly than  when  they  are  liberated  slowly 
and  diluted  with  air.  Liquid  commercial 
ammonia  sprinkled  about  a  room  after  formal- 
dehyde fumigation  will  remove  or  neutralize 
the  fumes  remaining  in  the  room. 


133 


BACTERIOLOGY  IN  A  NUTSHELL. 


TABLE  FOR  PREPARATION  OF  SOLUTIONS. 

Using  as  a  basis  7300  grains  to  the  pint. 
From  "Hospital  Formulary." 

To  Prepare  One  Pint  of  a  Solution 
Required  to  contain  of  a  certain  substance. 

Take  of  the  substance  the 
below  stated  amount  in 

Per  cent,  Or  grains       with       enough 

water  to  make  one  pint. 
..grains        0.73 
.  .grains 
.  .grains 
.  .grains 
.  .grains 
.  .grains 
.  .grains 


i/ioo  per  cent.  ..  . 

in 

1/50  per  cent  

in 

1/40  per  cent  

in 

1/30  per  cent  

in 

1/25  per  cent.  ..  . 

in 

1/20  per  cent.  ..  . 

in 

I/I5  P6*"  cent.  .  .  . 

in 

i/io  per  cent  

in 

J/5  per  cent.  .  .  . 

in 

1/4  per  cent  

in 

1/3  per  cent  

in 

1/2  per  cent  

in 

i  per  cent.  .  .  . 

in 

i  1/3  per  cent  

in 

2  per  cent  

in 

2*/2  per  cent  

in 

3  per  cent.  .  .  . 

in 

4  per  cent.  .  .  . 

in 

5  per  cent.  .  .  . 

in 

10  per  cent  

in 

20  per  cent  

in 

25  per  cent.  .  .  . 

in 

50  per  cent.  ..  . 

in 

m  4,000. 
in  3,000. 
in  2,500. 
in  2,000. 
in  1,500. 
in  1,000 grains 

500. 

400. 


(2/2) 
(3) 


1.46 
1.83 
2.44 
2.92 
3.65 
4.87 
7-30 

grains      14,60     (14^) 
grains      18.25     (i8j4) 

300 grains      24.33     (24^) 

200 grains      36.50     (36^) 

100 grains      73.00        (73) 

75....  grains      97.33 

50 grains     146.00 

40 grains     182.50 

33^3-.  grains    219.00       (219) 

25 grains    292.00       (292) 

20 grains    365.00       ( 365  ) 

10 grains    730.00       (730) 

5 grains  1460.00     (1460) 

4.  ...grains  1825.00     (1825) 
2 grains  3650.00     (3650) 


(97) 
(146) 
(180) 


The  following  simple  method  of  computing 
the  amount  of  a  liquid  drug  to  be  used  may  be 
found  useful  when  preparing  solutions  for  pur- 
poses in  which  absolute  accuracy  is  not  neces- 
sary. 

One  pint,  liquid  measure,  contains  seventy- 
six  hundred  and  eighty  (7,680)  minims — (3) 
16  X  (3)  8  X  (m)  60—  (m)  7,680—. 
134 


SUMMARY    AND    REVIEW. 

Multiply  the  number  of  minims  by  the  per 
cent  solution  required  and  the  result  gained 
will  be  the  amount  of  drug  in  minims  for  each 
pint  of  solution.  Divide  this  sum  by  sixty 
(60),  the  number  of  minims  in  a  dram,  and 
you  will  have  the  quantity  to  be  used  in  drams. 

Example. — To  make  one  pint  (OI)  of  a  five 
per  cent  solution : 

7680  X  .05  =384.00-^60=6.40,  or  about 
six  and  a  quarter  (6j4)  drams  of  the  drug  to 
each  pint  of  water. 

For  a  two  per  cent  solution  proceed  as  be- 
fore: 7680  X  .O2=i53.6o-r-6o=2.5'6,  or  about 
two  and  a  half  (2^)  drams  to  each  pint  of 
water. 

SUMMARY    OF    CHAPTER   VII. 

Harrington's  Solution — Strength  used. 

Carbolic  Acid  Solution — its  value  as  a  dis- 
infectant. Its  preparation  and  uses.  Its  un- 
certainty in  destroying  spores. 

Bichloride  of  Mercury  Solution — prepara- 
tion and  uses.  Its  power  to  precipitate  albu- 
minous deposits. 

Use  and  care  of  Peroxide  of  Hydrogen. 

Safe  method  of  disinfecting  excreta.  The 
preparation  of  lime  for  such  purposes. 

Lysol  and  Creolin  as  safe  antiseptics. 

Advantages  and  disadvantages  of  Potassium 
135 


BACTERIOLOGY  IN  A  NUTSHELL. 

Permanganate  as  a  disinfectant.  Oxalic  Acid 
in  comparison. 

Value  of  Normal  Salt  Solution.  Its  prepa- 
ration, when  and  how  used. 

How  Formalin  may  be  as  effective  as  bichlo- 
ride of  mercury,  or  carbolic  acid. 

Boracic  Acid,  mild,  non-irritating,  much 
used  for  the  purpose  of  irrigation. 

American  Standard  and  Thiersch's  Solution 
— their  composition  and  uses. 

Balsam  of  Peru  combined  with  an  oil  one  of 
the  best  dressings  for  burns. 

Sterile  Water — process  of  sterilization. 
Distilled  water.  Filtered  water  not  used  with- 
out sterilizing  in  aseptic  surgery. 

QUESTIONS  FOR  REVIEW. 

I. — Is  carbolic  acid  a  complete  germicide? 
In  what  class  of  diseases  is  it  safest  to  employ 
other  disinfectants  rather  than  carbolic  acid  ? 

State  accurately  how  to  prepare  a  carbolic 
acid  solution  suitable  for  use  in  surgical  prac- 
tice. 

II. — Why  is  bichloride  of  mercury  unsafe  to 
use  for  disinfecting  excreta?  Surgical  instru- 
ments? How  would  you  prepare  one  pint  of 
bichloride  of  mercury  solution  1-4,000  from  a 
solution  1-1,000  as  a  base? 

III. — What  can  you  say  of  the  efficiency  of 
136 


SUMMARY    AND    REVIEW. 

peroxide    of    hydrogen?     What    precautions 
should  be  taken  to  prevent  its  becoming  inert? 

IV. — What  can  you  say  of  the  value  of  lime 
as  a  disinfectant  ?  How  would  you  prepare  it 
for  use? 

V. — Name  several  points  in  favor  of  the  use 
of  lysol  as  an  antiseptic.  Also  mention  one  or 
two  disadvantages  of  potassium  permanganate. 

VI. — In  what  ways  does  the  use  of  normal 
salt  solution  benefit  the  patient  when  used  dur- 
ing or  after  operation  ? 

VII. — What  advantage  has  formalin  solu- 
tion over  bichloride  of  mercury  for  disinfecting 
excreta  ? 

VIII. — Why  is  the  free  use  of  boracic  acid 
safe? 

IX. — How  is  the  "American  Standard"  solu- 
tion prepared?  Also  "Thiersch's  Solution?" 
What  per  cent  solutions  of  the  balsam  of  Peru 
are  used  ?  Mention  a  common  base. 

X. — Describe  the  method  of  sterlizing  water. 
Is  it  safe  to  sterilize  water  without  filtering? 
And  is  distilled  water  safe  to  use  in  aseptic 
surgery  without  sterilizing? 

XL — Describe  the  process  of  sulphur  fumi- 
gation. What  are  its  disadvantages  ? 

XII.— What  is  formaldehyde?  State  why 
it  is  a  more  reliable  substance  to  use  for  fumi- 
gation than  sulphur.  Has  its  use  any  disad- 
vantages ? 

137 


CHAPTER  VIII. 


Result  of 
Neglected 
Hygienic  Laws 


Hygiene 
Defined. 


HYGIENE. 

Neglect  of  the  laws  of  hygiene  frequently 
brings  upon  the  human  structure  troubles 
which  so  weaken  its  various  organs  and  sys- 
tems that  access  and  development  of  bacteria 
therein  becomes  an  easy  matter.  It  seems  op- 
portune, therefore,  to  add  a  few  thoughts  along 
hygienic  lines. 

Nurses,  perhaps  more  than  any  other  class 
of  women,  should  not  only  understand  but  obey 
the  laws  of  Nature  as  revealed  to  us  in  the 
study  of  hygiene.  We  are  so  often  questioned 
by  sick  ones  entrusted  to  our  care  as  to  why 
certain  ills  have  come  into  their  lives.  Too 
often  they  suffer  from  diseases  brought  upon 
themselves  through  neglect  or  ignorance  of 
hygienic  laws.  While  it  is  not  within  the 
province  of  the  nurse  to  take  the  place  of  the 
physician,  whose  duty  it  is  to  explain  this  pain- 
ful truth  to  his  patient,  she  can  very  often 
afterward  help  the  sufferer  by  suggestion,  ad- 
vice and  example,  to  guard  against  future 
troubles. 

In  the  first  place,  then,  what  do  we  mean  by 
hygiene?  Hygiene  is  that  branch  of  science 
which  teaches  us  how  to  keep  healthy.  In  by- 
138 


HYGIENIC    SUGGESTIONS. 

gone  years,  so-called  civilization  and  the  ac- 
companying customs  of  the  day  laid  so  many 
restrictions  upon  women  that  it  was  impossible 
to  follow  fashion's  dictates  and  be  healthy  at 
one  and  the  same  time.  Young  girls  were  put 
into  tight  corsets,  French-heeled  shoes,  etc., 
when  scarcely  beyond  babyhood;  at  any  rate, 
before  they  were  fairly  in  their  teens  and  while 
they  should  still  have  been  at  play,  a  thing  quite 
out  of  the  question  for  the  poor  little  martyrs 
arrayed  in  such  outlandish  costumes.  In  fact, 
at  the  time  when  foolish  mothers  allowed  them- 
selves to  follow  fashion's  whims  and  so  torture 
their  young  daughters,  for  half-grown  girls  to  society»s 
romp  and  play  games  was  considered  a  social  Restrictions. 
outrage  and  if  young  women  were  to  attempt 
to  join  in  outdoor  sports  the  offense  was  rated 
about  next  door  neighbor  to  criminal.  While 
there  may  be,  and  probably  are,  many  who  still 
cling  to  such  erroneous  and  silly  notions,  the 
day  has  pretty  well  gone  by  when  established 
fashions  are  so  directly  opposed  to  the  laws  of 
health.  Woman  now-a-days  has  just  as  good 
opportunities  to  be  healthy  as  has  her  brother 
man.  In  this  age  young  girls  and  young  women 
may  join  with  members  of  the  "sterner  sex"  in 
games  of  tennis,  golf  and  croquet  without  Outdoor 
being  considered  "Tom  boys"  or  unladylike.  Games  No 
They  learn  to  swim  and  to  row,  to  climb  to  the  Tabooed. 
hilltops,  to  ride  horseback,  to  take  cali.sthenic 
139 


BACTERIOLOGY  IN  A  NUTSHELL. 


Hygiene  and 
Length  of  Days. 


Duty  Toward 
Our  Neighbor. 


exercises,  to  go  corsetless  if  they  want  to,  and 
to  wear  skirts  whose  trains  are  not  an  impedi- 
ment to  long,  brisk  walks  in  God's  pure  air 
and  sunshine,  all  without  danger  of  being 
called  or  thought  of  as  either  immodest  or 
ahead  of  the  age,  and  therefore  objects  for 
contempt. 

In  our  work  as  nurses  so  much  of  our  every- 
day duty  lies  within  doors  that  we  are  apt  to 
become  careless  or  forgetful  of  the  laws  which 
keep  us  healthy,  the  principal  and  most  import- 
ant ones  of  which  are  the  daily  bath,  fresh  out- 
of-door  air  and  sunshine  and  exercise,  also 
sufficient  rest  and  sleep  and  proper  food  taken 
at  regular  intervals.  Without  obedience  to 
these  laws  at  the  right  time  and  in  the  right 
way  the  nurse  cannot  satisfactorily  fulfill  her 
duty  to  those  the  physician  entrusts  to  her  care. 
If  she  attempts  it  she  soon  becomes  a  physical 
or  mental  wreck,  sometimes  both.  The  aver- 
age length  of  time  the  conscientious  nurse  is 
able  to  remain  in  active  service  as  care-taker  of 
the  sick  is  said  to  be  ten  to  fifteen  years.  The 
time  must  of  necessity  be  much  shorter  if  her 
health  is  neglected.  This  does  not  by  any 
means  signify  that  we  may  ever  shirk  duty. 
Oh,  no !  There  are  frequently  times  of  emerg- 
ency when  the  nurse,  especially  the  nurse  in 
private  work,  finds  it  impossible  to  have  her 
hours  "off  duty."  So  often  there  is  no  one  in 
140 


HYGIENIC    SUGGESTIONS. 

the  home  who  is  sufficiently  experienced  in  the- 
care  of  the  sick  to  be  trusted  to  relieve  her 
even  for  a  few  hours  of  much  needed  rest.  If 
the  expense  of  a  second  trained  nurse  cannot  be 
afforded,  then  the  path  of  duty  is  obvious. 
These  hours  of  danger,  as  a  rule,  do  not  last 
through  many  days.  Then  we  must  again 
take  up  our  "sponge"  and  "plunge"  baths,  our 
brisk  walks  in  the  fresh  air  and  sunshine  more 
rigorously  than  ever,  and  so  regain  our  lost 
tone. 

Let  us  decide  right  in  the  beginning  as  we 
enter  nursing  ranks  to  divide  our  time  of  recre- 
ation in  cultivating  all  the  aids  to  health  and 
usefulness  (not  neglecting  the  mind),  and  so 
prolong  the  "length  of  days"  we  shall  spend 
in  pursuit  of  our  high  and  noble  calling.  High 
and  noble  indeed  to  those  who  enter  the  work 
in  the  right  spirit.  Not  for  the  sake  alone  of 
the  money  in  it,*  although  the  financial  side  of 
the  question  is  important,  "surely  the  laborer 
is  worthy  of  his  hire,"  and  be  assured  that  to 
the  "worthy"  are  always  given  the  fruits  of 
their  labor  with  all  kindly  appreciation.  But 


*  The  writer  once  had  the  misfortune  to  hear  a  pupil 
nurse,  who  had  been  rebuked  for  neglect  of  duty,  make 
this  remark:  "I  don't  care  how  I  get  through  my  work 
in  training  school.  What  I  am  thinking  of  is  the  $20  a 
week  I  am  going  to  make  when  I  am  out  for  myself." 
Girls,  do  not  enter  the  field  in  such  a  spirit !  The  place 
for  such  nurses  is  outside  the  ranks  with  the  nurses 
who  cannot  control  temper. 
141 


BACTERIOLOGY  IN  A  NUTSHELL. 

let  us  remember,  also,  that  there  is  an  inborn 
love  of  the  work  paramount  in  the  heart  of 
every  nurse  who  ever  becomes  in  any  true  sense 
The  Successful  of  the  word  worthy  and  a  success.  Such 
nurses  enter  the  training-school  with  heart  and 
soul  and  mind  aglow,  with  hands  ready  and 
willing  accurately  to  perform  the  most  trivial 
or  the  most  difficult  tasks  with  equal  care  and 
promptness.  Physicians'  orders  are  carried  out 
promptly  and  accurately  and  are  "charted" 
neatly  and  concisely.  They  never  forget  that 
the  patient's  chart  is  a  history  of  the  case  to 
which  at  some  future  time  the  physician  may 
need  to  refer;  therefore,  every  symptom  is  ob- 
served carefully  and  is  recorded  faithfully. 
Their  patients  always  look  well  cared  for ;  their 
hair,  teeth,  tongue,  finger-nails  and  all  parts  of 
the  body  are  immaculate ;  their  beds  dainty  and 
sweet,  and  every  square  inch  of  the  sick  rooms 
or  wards  over  which  they  have  charge  is  as 
neat  and  clean  and  trim  as  human  hands  and 
observant  eyes  can  make  them.  These  are  the 
nurses  who  despise  gossip,  scorn  deceit  and  all 
petty  meanness,  and  who  realize  that  personal 
responsibility  is  attached  as  a  primary  link  in 
the  chain  of  "qualifications  of  the  good  nurse." 
This  realization  keeps  them  ever  on  the  alert 
to  add  to  this  primary  link  all  the  others  neces- 
sary to  make  them  not  only  good  nurses,  but 
the  best  nurses  possible. 
142 


HYGIENIC    SUGGESTIONS. 

While  realizing  our  duty  towards  others,  do 
not  let  us  forget  that  we  owe  a  duty  to  our- 
selves  also ;  that  we  are  responsible  to  God  for 
our  own  health.  There  are  broken-down 
nurses  in  the  world  today  who  ought  still  to  be 
in  active  service,  but  whose  condition,  through 
mistaken  ideas  of  duty,  renders  them  a  burden 
to  themselves  and  to  others. 

A  HEALTHY  MUSCULAR  SYSTEM. — We  are 
taught  when  studying  the  muscular  system  that  Nature's 
Nature  gives  to  each  individual  about  the  same 
kind  and  amount  of  muscle ;  that  the  difference 
in  strength  as  seen  in  different  people  is  due  in 
part  to  the  manner  in  which  they  are  taken  care 
of,  used,  disused  or  abused.  All  of  our  organs 
must  have  proper  exercise  in  order  to  be  kept 
healthy,  and  in  order  also  that  we  get  from 
them  that  service  for  which  they  were  intended. 

If  we  do  not  use  our  brains  in  study  while 
we  are  young  they  become  inactive  and  we  Resuits  Of 
grow  dull  and  stupid.  In  later  life  we  awaken  Inactivity, 
to  the  fact  that  there  are  a  great  many  things 
we  would  like  to  know  which  we  do  not  know, 
and  we  find  it  a  much  more  difficult  task  to 
get  our  brains  to  act  as  we  desire  them  to  than 
it  used  to  be.  Study  then  becomes  a  burden 
rather  than  a  pleasure.  In  the  same  way,  if  we 
do  not  exercise  the  voluntary  muscles  (those 
muscles  which  our  will  controls)  sufficiently, 
they  become  wasted  and  soft  and  flabby,  and 
143 


BACTERIOLOGY  IN  A  NUTSHELL. 


Results  of 
Overwork. 


Walking 
Develops  the 

Muscles. 


How  to  Walk. 


we  feel  the  effects  of  their  disuse  in  the  in- 
voluntary muscles  (those  muscles  over  which 
our  will  has  not  control).  The  heart  does  not 
do  its  best  work,  the  organs  of  respiration  and 
of  digestion  and  of  excretion  are  impaired,  and 
the  whole  structure  is  apt  to  suffer. 

On  the  other  hand,  if  the  voluntary  muscles 
are  abused  by  over-exercise  and  insufficient 
rest  we  have  other  evils  to  contend  against. 
They  wear  out  faster  than  Nature  can  supply 
the  new  material  with  which  to  rebuild  them, 
and  we  have  again  the  weak,  flabby  voluntary 
muscles,  and  suffering  to  endure  also  from  a 
weakened  condition  of  the  involuntary. 

EXERCISE. — Proper  muscular  exercise  then 
is  necessary  if  we  preserve  our  health.  Mus- 
cular development  of  the  arms  is  often  very 
noticeable  in  nurses  who  give  massage  treat- 
ment. Good,  brisk  walks  in  the  open  air  are 
conducive  to  the  development  of  all  the  muscles 
of  the  human  structure.  When  walking  do 
not  drag  along  as  if  not  quite  sure  what  your 
limbs  were  given  you  for.  It  is  necessary  to 
walk  briskly  in  order  to  keep  the  circulation 
just  right.  Keep  your  head  erect;  your 
shoulders  well  thrown  back  to  give  the  inspired 
air  a  chance  to  expand  the  lungs  and  keep 
them  in  good  working  trim.  Narrowchested 
people  become  such  very  often  because  they 
neglect  to  carry  themselves  erect  and  "square 
144 


HYGIENIC    SUGGESTIONS. 

their  shoulders"  when  they  stand  or  walk. 
Narrow-chested  people  court  tuberculosis.  To 
walk  several  miles  a  day  is  necessary  for  those 
whose  occupations  keep  them  indoors  most  of 
the  time. 

DRESS. — There  is  nothing  more  hygienic  in 

the  way  of  dress  than  the  nurses'  uniform,  but  JJOW  to 

J  Dress. 

it  was  never  designed  for  street  wear.     It  was 

designed  to  protect  the  sick  from  bacteria  so 
frequently  carried  to  them  in  the  woolen 
dresses,  as  well  as  by  the  soiled  hands,  of  those 
who  used  to  care  for  them,  and  who  knew  noth 
ing  of  the  laws  of  hygiene  as  trained  nurses 
understand  them  today. 

In  some  cities  nurses  seem  to  be  given  to  the 

habit  of  going  about  the  streets  and  on  street  Keep  the 
,,     •  -f  ,  f  Uniform 

cars  m  their  uniforms  when  out  for  a     con-  Sacred. 

stitutional."  This  practice,  if  they  but  stop  to 
think  about  it,  must  impress  them  as  all  wrong. 
We  can  never  tell  just  where  we  may  encounter 
a  communicable  disease,  just  as  likely  on  the 
street  cars  as  anywhere  else.  How  dreadful  to 
carry  its  germs  back  to  some  poor  sufferer  with 
already  enough  to  bear!  Let  our  uniform 
then  be  sacred  to  the  sick-room  alone,  but  let 
us  always  wear  it  there. 

Have  a  street  dress  which  is  simply  but  taste- 
fully    made     and     quickly     donned.     Wear  Pres.lt 

*  Sensibly, 

hygienic  waists,  and  skirts  suspended  from  the 

shoulders  rather  than  from  the  hips.     Wear 

H5 


BACTERIOLOGY  IN  A  NUTSHELL. 

sensible-looking,  neat  hats.  Nothing  is  much 
more  unprofessional  than  a  nurse  in  a  hat  on 
the  "flower  garden"  order,  or  who  is  adorned 
with  neck  chains,  rings,  "bangle"  bracelets,  and 
so  forth,  whose  skirts  sweep  the  streets  and 
gather  up  dust  and  bacteria  as  they  sweep. 
When  it  comes  to  exercising  in  garments  that 
constrict  the  chest  and  abdominal  muscles,  it 
is  quite  out  of  the  question.  How  can  the 
abdominal  or  pelvic  organs  remain  healthy 
when  thrown  into  unnatural  positions  by  pres- 
sure of  tight  corsets,  waist  bands  or  dragging 
skirts?  How  can  the  nurse  who  goes  out  in 
cold  or  wet  weather  only  half  clad  expect  to  be 
healthy?  Any  young  woman  is  deserving  of 
censure  who  goes  out  in  unseasonable  weather 
in  waists  and  skirts  on  the  spider-web  order 
over  gossamer  underclothing;  who  wears  also 
flimsy,  low-cut  shoes  and  the  thinnest  of 
hosiery ;  yet  we  try  to  excuse  her  on  the  plea  of 
"poor  judgment"  or  "a  lack  of  common  sense," 
but  for  the  nurse  there  should  be  no  excuse. 
In  her  daily  avocation  she  comes  in  contact  too 
majiy  times  with  the  fruits  of  just  such  errors 
in  judgment.  She  sees  in  all  their  sadness  the 
evils  brought  upon  the  human  frame  by  just 
such  indiscretions.  The  cold  that  developed 
after  exposure  to  the  elements ;  the  cough  that 
never  got  well;  the  wasted  pain-racked  frame, 
all  these  are  object  lessons  too  familiar  ever  to 
146 


HYGIENIC    SUGGESTIONS. 

be  lightly  overlooked  or  forgotten.  It  is  the 
nurse's  duty  to  dress  so  as  to  be  healthy.  Her 
work  demands  health.  There  is  no  room  in  the 
ranks  for  the  nurse  who  "enjoys  poor  health/' 

Let  us  all  try  to  be  healthy. 

THE  BATH. — Nothing  is  more  conducive  to 
good  vigorous  health  than  proper  and  system-  The  Various 
atic  bathing.  Few  things  are  more  restful  to  Baths- 
the  tired  nurse  when  she  comes  off  duty  than  a 
good  warm  salt  bath  before  retiring.  A  pint 
of  sea  salt,  or  common  salt,  to  each  two  gallons 
of  water  is  a  fair  proportion.  Take  a  good 
"rub"  with  a  Turkish  towel  on  emerging  from 
the  bath.  A  cold  sponge  bath  should  be  taken 
in  the  morning  when  you  rise.  Many  recom- 
mend a  cold  "plunge"  bath  and  find  it  very 
healthful  when  taken  quickly  and  followed  by  a 
brisk  rubbing,  but  it  is  a  bath  not  suited  to  all 
constitutions.  Those  who  find  a  cold  plunge 
too  severe,  often  enjoy  getting  into  a  tepid  bath 
and  gradually  lowering  the  temperature  until 
it  is  cold.  A  good  soap  and  water  tub  bath 
several  times  a  week  seems  necessary  to  health- 
ful conditions,  in  addition  to  "salt"  baths, 
"sponges"  and  "plunges."  When  taking  a 
bath  after  a  meal,  allow  two  hours  to  elapse 
before  beginning  operations. 

THE  HAIR,  THE  TEETH,  THE  NAILS,  ETC.— :- 
Take  care  of  your  hair  and  keep  it  well  sham-  Disinfect  the 
pooed.     Diseases  can  be  communicated  from      air 
i47 


Obey  the 
Calls  of 
Nature. 


A  Mixed  Diet. 


BACTERIOLOGY  IN  A  NUTSHELL. 

one  to  another  by  bacteria  which  fasten  upon 
the  hair,  as  well  as  upon  the  skin,  beneath  the 
finger  nails  and  within  the  mouth.  Do  not 
forget  these  points  when  carrying  out  personal 
disinfection  at  the  close  of  nursing  a  commun- 
icable disease.  The  toilet  is  never  complete 
until  the  hair,  the  teeth  and  the  finger  nails  are 
as  immaculate  as  the  dress  and  the  rest  of  the 
person. 

Do  not  forget  that  neglect  of  Nature's  calls 
leads  to  habitual  constipation,  cystitis  and  other 
evils  allied  to  these.  Write  this  truth  in  cap- 
itals upon  your  memories.  It  will  save  you 
lots  of  trouble. 

FOOD  AND  WATER  SUPPLY. — In  order  to 
keep  healthy,  food  should  not  only  be  taken  at 
regular  intervals  and  in  proper  quantities,  but 
it  should  also  be  of  the  most  nutritious,  easily 
digested  and  assimilated  character.  Pastry 
and  sweets  should  be  partaken  of  very  moder- 
ately, if  at  all.  The  heaviest  meal  of  the  day 
should  not  come  in  the  evening  when  the  diges- 
tive system  is  tired  from  the  exertions  of  the 
day  and  needs  rest.  A  mixed  diet,  consisting 
of  meat,  vegetables,  fruit,  bread,  eggs  and  milk, 
will  be  found  more  valuable,  when  planning  for 
a  healthful  diet,  than  the  cranky  idea  of  living 
entirely  upon  vegetables  or  going  to  the  other 
extreme  and  cutting  them  out  of  the  food  list 
entirely. 

148 


HYGIENIC    SUGGESTIONS. 

Do  not  drink  cold  water,  particularly  ice- 
cold  water,  with  your  meals.  It  chills  the  Water  Supply. 
stomach  and  retards  digestion.  The  human 
structure  requires  plenty  of  water  to  keep  the 
wheels  of  its  complex  machinery  in  good  run- 
ning order,  but  this  water  supply  should  be 
taken  in  between  meals  and  should  be  as  pure 
as  filtering  and  boiling  will  make  it.  Put  the 
pitcher  containing  the  water  on  the  ice  instead 
of  putting  ice  into  the  pitcher.  Few  germs,  if 
any,  are  entirely  destroyed  by  freezing.  They 
usually  thaw  out  and  again  renew  their  ac- 
tivities. Typhoid  fever  germs  live  all  winter 
in  pond  ice  and  in  the  spring  and  following 
summer  are  just  as  powerful  as  ever  to  spread 
infection. 

REST  AND  SLEEP. — Do  not  sleep  or  rest  in  a 
stuffy,  dusty,  badly  ventilated  room.  Remem-  Ventilate  Your 
ber  to  have  between  two  and  three  thousand  Sleeping  Rooms, 
cubic  feet  of  fresh  air  in  all  sleeping  rooms  and 
especially  in  sick-rooms.  This  amount  of  air 
we  have  already  said,  when  speaking  of  "com- 
municable diseases,"  is  found  in  a  room  twenty 
feet  long  by  fifteen  feet  wide  with  a  ceiling  ele- 
vation of  ten  feet,  provided  the  current  of  air 
is  changed  frequently  to  keep  it  pure.  The 
windows  should  always  be  open  at  the  top  and 
to  aid  in  the  regular  changing  of  impure  for 
pure  air,  open  them  up  from  the  bottom  for  a 
while  every  day  and  open  the  doors  also.  Do 
149 


BACTERIOLOGY  IN  A  NUTSHELL. 


Remove 

Day  Garments. 


Untidy 
Nurses. 


Let  the 
Sunshine  Inv 


The  Sunny 
Nurse. 


not  rest  or  sleep  in  a  current  of  air.  It  is  an 
injurious  habit  for  even  the  most  vigorous. 

Do  not  sleep  in  any  garment  worn  during  the 
day.  Learn  to  relax  the  muscles  when  resting. 
Do  not  sleep  with  a  pile  of  pillows  beneath  the 
head;  use  only  a  small  pillow.  Better  no  pil- 
low at  all  than  to  be  held  up  in  almost  a  sitting 
position  all  night,  rounding  the  shoulders  and 
making  the  chest  hollow. 

Keep  your  own  room  clean  and  neat.  It  is 
a  matter  quite  surprising  to  find  any  number 
of  nurses  whose  rooms  look  as  if  "a  cyclone  had 
struck  them/'  and  yet  who  would  not  be 
guilty  of  such  negligence  if  they  were  more 
thoughtful  of  laws  of  health  as  applied  per- 
sonally. 

SUNSHINE. — Sleeping  rooms  and  all  rooms 
occupied  by  the  delicate  should  be  rooms  with  a 
southern  exposure,  so  as  to  have  the  effects  of 
the  sun's  rays  for  the  greater  part  of  the  day. 
Not  only  should  we  live  in  the  sunshine  as 
much  as  possible,  but  we  should  ourselves  be 
sunny.  The  only  place  for  the  gloomy  nurse 
is  with  the  mercenary  nurse,  the  untrustworthy 
nurse  and  the  nurse  who  "enjoys  poor  health" 
— outside  the  ranks.  This  thought  is  par- 
ticularly applicable  to  those  nurses  who  hon- 
estly desire  to  be  successful.  Those  with  a 
sunny  disposition  are  always  at  a  premium. 
What  sick  one  can  fail  to  love  and  desire  to 
150 


HYGIENIC    SUGGESTIONS. 

have  about  her  the  nurse  with  a  "southern  ex- 
posure." She  fairly  beams  as  she  enters  the 
sickrroom,  and  no  matter  how  plain  her  face 
this  nurse  always  looks  beautiful  in  the  eyes  of 
the  sufferer,  to  whom  she  invariably  seems  to 
communicate  sunshine,  the  power  of  which 
dissolves  and  drives  away  all  gloomy  forebod- 
ings. She  cannot  fail  to  cure  the  "blues,"  for 
the  sorriest  grumbler  in  the  "slough  of  de- 
spond" on  the  sick  list  must  needs  feel  ashamed 
of  such  moods  in  the  presence  of  the  sunny 
nurse. 

Let  us  all  learn  to  let  the  sunshine  into  our 
hearts  as  well  as  to  let  it  shine  upon  us.  "Let 
the  sunshine  in"  and  it  will  radiate  from  the 
eyes  and  the  smile  of  the  good  nurse ;  be  felt  in 
the  touch  of  her  gentle,  kindly  hand,  and  in  the 
tones  of  her  cheerful,  hope-inspiring  voice. 

It  is  not  only  the  blessed  privilege  of  each 
nurse  to  be  the  best  nurse  possible  and  to  be  all 
that  is  truest,  purest  and  most  perfect  among 
women,  but  it  is  also  her  duty.  May  we  each 
strive  to  grasp  this  duty  as  Heaven-born,  so 
shall  every  nurse  be  beloved  and  in  being  be- 
loved do  her  best  and  noblest  work. 

"The  world  may  sound  no  trumpet,  ring  no  bells, 
The  Book  of  Life  the  shining  record  tells." 


BACTERIOLOGY  IN  A  NUTSHELL. 
SUMMARY  OF  CHAPTER  VIII. 

Ills  brought  upon  the  human  structure  by 
neglect  of  hygienic  laws. 

Fashions  of  bygone  days  opposed  to  laws  of 
health. 

Restrictions  of  society  with  regard  to  games, 
dress,  and  so  forth,  a  thing  of  the  past. 

Forgetfulness  on  the  part  of  the  nurse  with 
regard  to  hygiene  may  be  the  cause  of  a  short- 
ened period  of  usefulness.  Following  its  pre- 
cepts may  lengthen  the  period. 

How  success  is  obtained  by  the  good  nurse. 

Walking  and  dressing  sensibly.  The  sensi- 
ble dress  the  hygienic  dress. 

Keeping  the  uniform  sacred  to  the  sick- 
room, and  why. 

Bathing  and  when  to  bathe  so  as  to  be 
healthy.  The  care  of  the  hair,  the  teeth  and 
attention  to  Nature's  calls. 

Proper  diet  and  sufficient  water  supply 
necessary  to  health. 

Ventilation.  Fresh  air,  sunshine  and  a 
sunny  disposition  and  their  effects. 


152 


HYGIENIC    SUGGESTIONS. 
QUESTIONS    FOR    REVIEW. 

I. — What  is  hygiene? 

II. — Why  is  it  necessary  to  both  study  and 
practice  the  teachings  of  hygiene  ? 

III. — How  does  manner  of  dress  infringe 
upon  laws  of  health?  Explain  why  uniform 
should  not  be  worn  on  the  street. 

IV. — Why  should  outdoor  sports  and  ex- 
ercise be  encouraged? 

V. — Is  the  nurse  responsible  for  the  care  of 
her  own  health  as  well  as  that  of  her  patient? 

VI. — Is  she  often  excusable  for  neglecting 
outdoor  exercise,  baths,  hours  of  sleep,  Na- 
ture's calls? 

VII. — Why  should  a  mixed  diet  which  is 
nutritious,  easily  assimilated  and  digested  be 
adhered  to? 

VIII. — Explain  why  fresh  air,  sunshine  and 
clean,  well-ventilated  apartments  are  necessary 
to  health. 

IX. — Is  the  nurse  who  does  not  try  to  keep 
healthy  just  as  much  out  of  place  in  the  nursing 
world  as  the  nurse  who  does  not  try  to  control 
her  temper  ?  Give  reasons  for  your  answer. 

X. — Why  should  a  nurse  above  all  other 
women  aspire  to  be  one  of  its  purest,  brightest 
and  noblest  types  ? 


153 


INDEX. 


Acid,  boracic,  128. 

"     carbolic,  16,  121. 

"     oxalic,  125. 
Air,  45,  72,  149. 
Aikens,  Miss  C.  A.,  6-7. 
Alcohol,  130. 
Alcohol  "rub,"  73. 
American  Standard,  128. 
Ammonia,  28,  133. 
Animal  life,  27-31. 
Antisepsis,  102-107. 
Antiseptics,  108. 
Antitoxins,  59-62. 
Arthritis  deformans,  20. 
Asepsis,  102-107. 
Assistant,  105. 

"         mistake  of,  109. 


B. 


Bacilli,  definition  of,  34. 
Bacillus,  cholera,  18,  75. 

diphtheriae,  18,  76. 

of  Friedlander,  17. 
"        of  leprosy,  16. 

pestis,  96. 

tuberculosis,  17,  85. 

tetani,  18,  81,  103. 

typhosus,  17,  65. 

yellow  fever,  19. 
Bacteria,  classification,  34. 

coloring,  37. 
"        definition,  31. 

destruction,  37,  38. 

in  the  diseased,  38. 

in  the  healthy,  37,  38. 

in  natural  processes,  29,  30,  31. 

most  important,  34. 

movement,  37. 

multiplication,  36-37. 

parasitic,  27. 

saprophytic,  27. 

size  of,  36. 

transparency,  37. 

154 


BACTERIOLOGY  IN  A  NUTSHELL. 

Barton,  Dr.,  95. 

Bathing,  147. 

Bichloride  of  mercury,  122,  123. 

Brains,  143. 

Bread,  148. 

Bubonic,  plague,  18,  19,  96. 

C. 

Capsule,  41. 
Caps,  ice,  73. 
Carbon,  28. 
Carbonic  acid  gas,  30. 
Carbon  dioxide,  30. 
Cells,  24,  26. 

Cerebro-spinal  meningitis,  90. 
Cholera,  75. 
Chlorine  solution,  14. 
Circuit,  Koch's,  62. 
Cleanliness,  148. 
Communicable  diseases,  65-101. 

"        channels  of  entrance,  65-101. 

"        methods  of  communication,  65-101 

nursing  in,  65-101. 
Compound  microscope,  10. 
Contents,  3-4. 
Councilman,  19,  97. 
Creolin,  125. 

Croup,  membraneous,  77. 
Cultures,  19,  34,  35. 

D. 

Dairy,  the,  68. 

Dairies  (note),  68. 

Decay,  trees  and  plants,  29. 

"      animals,  29,  30. 
Deodorants,  108. 
Desquamation,  78,  84,  98. 
Devaine,  14. 
Diet,  148. 
Dioxygen,  123. 
Diphtheria,  18,  76. 
Diplococci,  35,  90,  103. 
Diplococcus  lanceolatus,  17,  92. 
Disease,  definition,  25. 
Disinfectants,  conditions  modify,  108. 
Disinfection,  70,  107-108. 

of  hands,  etc.,  113. 
Dress,  145. 
Dysentery,  75. 

155 


BACTERIOLOGY  IN  A  NUTSHELL. 

E. 

Eberth,  17,  65. 

Epidemics,  68,  76,  78,  91,  94. 

Erysipelas,  83. 

Ether,  130. 

Elephantiasis,  94. 

F. 
Fever,  17. 

bathing  in  (note),  73. 
relapsing,  94. 

"      specific  (note),  98. 

"      scarlet,  78-80. 

"      typhoid,  17,  65-75,  149. 

"      yellow,  95. 
Filariasis,  94. 
Finlay,  Dr.,  95. 
Fission,  39. 
Flies,  51,  96,  98. 
Flagella,  37. 
Formaldehyde,  132,  133. 

lamps,  133. 
Formalin,  127,  132. 
Fraenkel,  17,  92. 
Friedlander,  17. 
Fumigation,  130,  133. 

G. 

German  measles  (Roseola),  78. 
Germicides,  108. 
Glands,  Peyerian,  66. 
Gonorrhoea,  16. 

H. 

Hemorrhage,  66. 
Hair,  the,  148. 
Hanson,  16. 
Health,  71. 
Healthy  exercise,  144. 

games,  139. 

muscle,  144. 
Henle,  11. 
Hoffman,  27. 
Hydrogen  peroxide,  123. 

dioxide,  123. 
Hygiene,  138-153. 

denned   138. 

neglected,  138. 

personal,  71. 
Hygienic  dress,  145. 

156 


BACTERIOLOGY  IN  A  NUTSHELL 

I. 

Ice  water,  149. 

Ilium,  66. 

Immunity,  49-54. 

Incubation,  46. 

Infection,  46. 

Influenza,  79. 

Inoculation,  14,  45. 

Introductory,  5-7. 

Invasion,  66. 

Iodine  solution,  121.  f 

K. 

Kitasato,  18. 

Klebs,  15. 

Koch,  17,  18,  19,  65,  89. 

Koch,  Sister  Emilie,  1. 

L. 

La  grippe,  18,  78. 
Leeuwenhoek,  9,  11. 
Lens,  single,  9. 
Leprosy,  16. 
Lesion,  45. 

Lister,  Sir  Joseph,  16   107. 
Loeffler,  18. 
Lysol,  124. 

M. 

Malaria,  88. 

Malariae,  plasmodium,  88. 

Maternity,  hopitals  (note),  106. 

Measles,  78. 

Meat,  69,  148. 

Meningitis,  90. 

Metschnikoff,  38,  52,  53. 

Micrococci,  34. 

Micro-organisms,  26. 

Milk,  68,  148. 

Milk  of  Lime,  123. 

"Modified  Oath,"  8. 

Morphology,  34. 

Mosquitoes,  88,  95. 

Mumps,  81. 

N. 

Nails,  the,  148. 
Nature's  gifts,  143. 
Neisser.  16. 
Nicolaier,  18. 
Nitrogen,  28. 

157 


BACTERIOLOGY  IN  A  NUTSHELL. 

Normal  salt  sol.,  126. 

some  uses  of,  127. 
Nurse,  the  bad  tempered,  142. 
'        "    good,  142. 
(    healthy,  147. 
1    mercenary,  141. 
'    neat,  145. 
'    successful,  142. 
'    sunny,  150-153. 
"    some  qualifications  of,  8,  142. 
Nursing,  65-99. 

and  gossip,  142. 

O. 

Obermeier,  16,  94. 
Opsonins,  38,  54. 
Opsonic  Theory,  54-59. 
Oxygen,  30-31. 

P. 

Parkes'  list,  44. 

Pasteur,  14,  15,  54. 

Pasteurized  milk,  69,  80. 

Pastry,  148. 

Perforation,  66. 

Peritonitis,  66. 

Peru,  balsam,  129. 

Pfeiffer,  18. 

Phagocytes,  38,  46. 

Plant  life,  27-31. 

Plenciz,  9,  10. 

Pneumonia,  17,  92. 

Poisons,  28,  59. 

Pollender,  14. 

Potassium  permanganate,  125. 

Protoplasm,  40. 

Protozoa,  26. 

"Protozoon,"  97. 


Rest,  149. 
Rheumatism,  20. 
Roseola,  78. 
Rowe,  Dr.  J.  W.,  6. 
Rush,  Dr.,  95. 

S. 

Sanarelli,  19. 
Sarcinae,  39. 
Schaudinn,  19. 

158 


BACTERIOLOGY  IN  A  NUTSHELL. 

Schulze,  12. 
Semmelweis,  13,  14. 
Sepsis,  104,  107. 
Smallpox,  19,  97. 
Solutal,  124. 
Solutions,  120,  124. 

table  for  preparation  of,  134. 
Spirilla,  35. 

Spirochetae  pallidae,  19. 
Spores,  35,  36,  39,  40. 
Staphylococci,  38,  39,  102. 
Sterilization,  107-110. 

Intermittant,  110. 
Sternberg,  17. 
Streptococci,  38,  39,  103. 
Sublamine,  123. 
Sulphur,  130. 
Surgery,  bacterian  in,  102. 

antiseptic,  16. 

aseptic,  110-113. 
Sunshine,  65,  150. 
Sweets,  148. 
Syphilis,  19. 

T. 

Tate,  Dr.  M.  A.,  6. 
Table  for  solutions,  134. 
Teeth,  the,  148. 
Tetanus,  81. 

preventive  measures,  82. 
Tetrads,  39. 

Thiersch's  solution,  128. 
Tricresol,  124. 
Toy  pistols,  81. 
Tuberculosis,  85. 

predisposition  to,  86. 
nursing  in,  87. 

U. 

Ulceration,  66. 
Uniform,  145. 
Uncinariasis,  89. 
Uncinaria  duodenalis,  89. 

V. 

Vaccination,  54,  62,  99. 
Varro,  9. 

Vegetable  life,  28-31. 
Vegetables,  68,  148. 
Ventilation,  72,  77. 

159 


BACTERIOLOGY  IN  A  NUTSHELL. 
Vidal  (note),  75. 

Water,  distilled,  129. 

"      filtered,  129. 

"      sterile,  129. 
Weigert,  37. 
Weightman,  Dr.,  95. 
Whooping  cough,  77. 
"Widal's  Test,"  74. 
Wright,  Sir  Almoth,  38,  56. 
Wood,  Dr.,  95. 
Wyman,  Dr.,  96. 

Y. 

Yersin,  18. 

Z. 

Zinke,  Dr.  E.  Gustave,  6-7. 


160 


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